MEDICARE: SALIDA DEL SOL ADHC, LLC

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		CA

General Provider Information

NPI Number	:	1619158839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALIDA DEL SOL ADHC, LLC

Provider Business Mailing Address
First Line	:	2001 W OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-3705
Country	:	US
Telephone Number	:	213-736-9450
Fax Number	:	212-736-9457

Provider Business Practice Location Address
First Line	:	2001 W OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-3705
Country	:	US
Telephone Number	:	213-736-9450
Fax Number	:	212-736-9457

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. FRIDA VAYSMAN
Credential	:
Telephone Number	:	213-736-9450

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	11/15/2007

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