Provider Demographics
NPI:1992993661
Name:CARSON ADULT DAY HEALTH CARE CENTER,INC.
Entity type:Organization
Organization Name:CARSON ADULT DAY HEALTH CARE CENTER,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:FAJARDO
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-354-0078
Mailing Address - Street 1:PO BOX 11067
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90749-1067
Mailing Address - Country:US
Mailing Address - Phone:310-354-0031
Mailing Address - Fax:310-354-3939
Practice Address - Street 1:451 E CARSON PLAZA DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3247
Practice Address - Country:US
Practice Address - Phone:310-354-0031
Practice Address - Fax:310-354-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care