Provider Demographics
NPI:1508226440
Name:ACTIVE LIFE ADULT DAY CARE, INC.
Entity Type:Organization
Organization Name:ACTIVE LIFE ADULT DAY CARE, INC.
Other - Org Name:ACTIVE LIFE ADULT DAY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAMANOUKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-643-6003
Mailing Address - Street 1:7209 TAM O'SHANTER DR
Mailing Address - Street 2:UNIT D
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3370
Mailing Address - Country:US
Mailing Address - Phone:626-643-6003
Mailing Address - Fax:209-267-4193
Practice Address - Street 1:7209 TAM O'SHANTER DR.
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210
Practice Address - Country:US
Practice Address - Phone:626-643-6003
Practice Address - Fax:209-267-4193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care