Provider Demographics
NPI:1699873471
Name:EVERLASTING ADULT DAY CARE INC
Entity type:Organization
Organization Name:EVERLASTING ADULT DAY CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:LICTAOA
Authorized Official - Last Name:JORNACION
Authorized Official - Suffix:
Authorized Official - Credentials:CPA MBA
Authorized Official - Phone:323-433-3521
Mailing Address - Street 1:4515 EAGLE ROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-3214
Mailing Address - Country:US
Mailing Address - Phone:323-433-3525
Mailing Address - Fax:323-344-3501
Practice Address - Street 1:4515 EAGLE ROCK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-3214
Practice Address - Country:US
Practice Address - Phone:323-433-3525
Practice Address - Fax:323-344-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
2220835Medicare UPIN