Provider Demographics
NPI:1487864468
Name:INGLEWOOD COMMUNITY ADHC
Entity Type:Organization
Organization Name:INGLEWOOD COMMUNITY ADHC
Other - Org Name:MAGNOLIA ADULT DAY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATALY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOURABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-266-6494
Mailing Address - Street 1:490 M. MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020
Mailing Address - Country:US
Mailing Address - Phone:619-444-1522
Mailing Address - Fax:619-444-1516
Practice Address - Street 1:490 M. MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020
Practice Address - Country:US
Practice Address - Phone:619-444-1522
Practice Address - Fax:619-444-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060000821OtherLICENSE
CAADU70302FOtherPROVIDER NUMBER