MEDICARE: FIVE ACES HEALTH CARE CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center	060000731	CA

General Provider Information

NPI Number	:	1053523142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE ACES HEALTH CARE CORPORATION

Provider Business Mailing Address
First Line	:	18800 AMAR RD
Second Line	:	SUITE D-5
City	:	WALNUT
State	:	CA
Zip	:	91789-4166
Country	:	US
Telephone Number	:	626-581-4034
Fax Number	:	626-581-1356

Provider Business Practice Location Address
First Line	:	18800 AMAR RD
Second Line	:	SUITE D-5
City	:	WALNUT
State	:	CA
Zip	:	91789-4166
Country	:	US
Telephone Number	:	626-581-4034
Fax Number	:	626-581-1356

Authorized Official
Title or Position	:	FISCAL OFFICER
Name	:	MR. ALDRIN HALABASO FESTEJO
Credential	:
Telephone Number	:	626-581-4034

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	06/27/2008

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