Provider Demographics
NPI:1376690909
Name:CLAIREMONT VILLA ADULT DAY HEALTH CENTER
Entity Type:Organization
Organization Name:CLAIREMONT VILLA ADULT DAY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERGOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-337-5483
Mailing Address - Street 1:10174 OLD GROVE RD STE 100
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131
Mailing Address - Country:US
Mailing Address - Phone:858-576-8575
Mailing Address - Fax:858-576-8424
Practice Address - Street 1:10174 OLD GROVE RD STE 100
Practice Address - Street 2:STE. 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131
Practice Address - Country:US
Practice Address - Phone:858-576-8575
Practice Address - Fax:858-576-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care