Provider Demographics
NPI:1396201828
Name:SPECTRUM ADULT DAY HEALTH SERVICES INC
Entity Type:Organization
Organization Name:SPECTRUM ADULT DAY HEALTH SERVICES INC
Other - Org Name:SAN DIEGO FAMILY CIRCLE ADULT DAY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:POLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-952-8531
Mailing Address - Street 1:5770 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7303
Mailing Address - Country:US
Mailing Address - Phone:858-952-8531
Mailing Address - Fax:858-724-3302
Practice Address - Street 1:4428 CONVOY ST STE 288
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3761
Practice Address - Country:US
Practice Address - Phone:802-430-7543
Practice Address - Fax:856-724-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396201828Medicaid