Provider Demographics
NPI:1255850814
Name:MAGNOLIA ADULT DAY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:MAGNOLIA ADULT DAY HEALTH CARE, INC.
Other - Org Name:ABC SANTA ANA DAY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-894-5880
Mailing Address - Street 1:202 HOSPITAL CIR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3910
Mailing Address - Country:US
Mailing Address - Phone:714-894-5880
Mailing Address - Fax:
Practice Address - Street 1:206 W 15TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2307
Practice Address - Country:US
Practice Address - Phone:657-210-2379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGNOLIA ADULT DAY HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care