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General NPI Number Information
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NPI Number | 1396201828
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Entity Type | Organization
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Legal Business Name | SPECTRUM ADULT DAY HEALTH SERVICES INC
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 4428 CONVOY ST STE 288
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City | SAN DIEGO
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State | CA
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Zip | 92111-3761
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Country | US
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Telephone | 802-430-7543
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Fax | 856-724-3302
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Provider Business Mailing Address
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Address Line | 5770 BELLEVUE AVE
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City | LA JOLLA
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State | CA
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Zip | 92037-7303
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Country | US
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Telephone | 858-952-8531
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Fax | 858-724-3302
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Authorized Official
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Title or Position | OWNER
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Name | MR. GARY POLSKY
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Credential |
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Telephone | 858-952-8531
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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 |
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