Provider Demographics
NPI:1578857520
Name:ADULT HEALTH CARE CLINIC LLC
Entity Type:Organization
Organization Name:ADULT HEALTH CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:671-647-5546
Mailing Address - Street 1:2211 ARMY DR STE 105
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-1267
Mailing Address - Country:US
Mailing Address - Phone:671-647-5546
Mailing Address - Fax:671-647-5550
Practice Address - Street 1:2211 ARMY DR STE 105
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-1267
Practice Address - Country:US
Practice Address - Phone:671-647-5546
Practice Address - Fax:671-647-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1378261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service