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General NPI Number Information
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NPI Number | 1689133621
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Entity Type | Organization
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Legal Business Name | LUCKY STARS ADULT DAY HEALTH CARE CENTER, INC
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 19715 COLIMA RD UNIT B
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-3211
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Country | US
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Telephone | 909-957-9995
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Fax |
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Provider Business Mailing Address
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Address Line | 8300 UTICA AVE STE 300
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3852
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Country | US
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Telephone | 909-957-9995
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TAMMY WANG
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Credential | MS, RD, CCS,
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Telephone | 909-655-6168
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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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