Provider Demographics
NPI:1154055895
Name:EMPIRE HEALTH SYSTEMS OC, INC.
Entity Type:Organization
Organization Name:EMPIRE HEALTH SYSTEMS OC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GLADELYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADLAO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:909-345-5099
Mailing Address - Street 1:9191 BOLSA AVE STE 208-209
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5564
Mailing Address - Country:US
Mailing Address - Phone:909-345-5099
Mailing Address - Fax:
Practice Address - Street 1:9191 BOLSA AVE STE 208-209
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5564
Practice Address - Country:US
Practice Address - Phone:909-345-5099
Practice Address - Fax:818-697-8322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service