Provider Demographics
NPI:1396964110
Name:KHEIR MIRAE ADULT DAY HEALTH CARE CENTER
Entity type:Organization
Organization Name:KHEIR MIRAE ADULT DAY HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO - ADHC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-427-4000
Mailing Address - Street 1:3727 W 6TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-5108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:717 S WESTERN AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-3113
Practice Address - Country:US
Practice Address - Phone:213-427-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOREAN HEALTH EDUCATION INFORMATION AND RESEARCH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-24
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000909261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70398FOtherPROVIDER NUMBER