Provider Demographics
NPI:1669645636
Name:QUANTUM ADULT DAY HEALTH CARE CENTER
Entity Type:Organization
Organization Name:QUANTUM ADULT DAY HEALTH CARE CENTER
Other - Org Name:PROMISE HOSPITAL OF SAN DIEGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-869-3100
Mailing Address - Street 1:999 YAMATO ROAD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:561-869-3100
Mailing Address - Fax:561-826-0171
Practice Address - Street 1:5550 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-2307
Practice Address - Country:US
Practice Address - Phone:619-582-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMISE HOSPITAL OF SAN DIEGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-10
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA090000105282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70363GMedicaid