Provider Demographics
NPI:1093807661
Name:ALZHEIMER'S FAMILY SERVICES CENTER
Entity Type:Organization
Organization Name:ALZHEIMER'S FAMILY SERVICES CENTER
Other - Org Name:ADULT DAY SERVICES OF ORANGE COUNTY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CORDULA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICK-MUEHLKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-593-1840
Mailing Address - Street 1:9451 INDIANAPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-5955
Mailing Address - Country:US
Mailing Address - Phone:714-593-9630
Mailing Address - Fax:714-593-9632
Practice Address - Street 1:9451 INDIANAPOLIS AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-5955
Practice Address - Country:US
Practice Address - Phone:714-593-9630
Practice Address - Fax:714-593-9632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000393261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70098FOtherMEDI-CAL PROVIDER