Provider Demographics
NPI:1326559782
Name:MOLLISON ADULT DAY CARE INC.
Entity Type:Organization
Organization Name:MOLLISON ADULT DAY CARE INC.
Other - Org Name:ADULT DAY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOALOA
Authorized Official - Middle Name:N
Authorized Official - Last Name:KARANA SHAMOUN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:619-551-2133
Mailing Address - Street 1:8744 GOLF DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1009
Mailing Address - Country:US
Mailing Address - Phone:248-819-1422
Mailing Address - Fax:619-303-7876
Practice Address - Street 1:115 S MOLLISON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4814
Practice Address - Country:US
Practice Address - Phone:619-551-2133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care