Provider Demographics
NPI:1306659677
Name:LUCKY ADULT DAY HEALTH CARE CENTER INC
Entity type:Organization
Organization Name:LUCKY ADULT DAY HEALTH CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:QADEER
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-547-0202
Mailing Address - Street 1:9420 RESEDA BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-6000
Mailing Address - Country:US
Mailing Address - Phone:949-547-0202
Mailing Address - Fax:818-349-2558
Practice Address - Street 1:17661 COWAN
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6031
Practice Address - Country:US
Practice Address - Phone:949-547-0202
Practice Address - Fax:818-349-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care