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General NPI Number Information
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NPI Number | 1295944155
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Entity Type | Organization
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Legal Business Name | SOUTH COUNTY SENIOR SERVICES
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 24300 EL TORO RD BLDG. A
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City | LAGUNA WOODS
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State | CA
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Zip | 92637-2737
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Country | US
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Telephone | 949-855-9444
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Fax | 949-855-4093
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Provider Business Mailing Address
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Address Line | 24300 EL TORO RD BLDG. A
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City | LAGUNA WOODS
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State | CA
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Zip | 92637-2737
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Country | US
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Telephone | 949-855-9444
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Fax | 949-855-4093
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. JACK WALTER LIGHT
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Credential | LCSW
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Telephone | 949-855-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | CA
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