Provider Demographics
NPI:1629253778
Name:CALLOWAY HEALTH CARE, LLC
Entity Type:Organization
Organization Name:CALLOWAY HEALTH CARE, LLC
Other - Org Name:MARINA DEL REY ADHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-821-3599
Mailing Address - Street 1:2929 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5546
Mailing Address - Country:US
Mailing Address - Phone:310-821-3599
Mailing Address - Fax:310-821-3387
Practice Address - Street 1:2929 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5546
Practice Address - Country:US
Practice Address - Phone:310-821-3599
Practice Address - Fax:310-821-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care