Provider Demographics
NPI:1689133621
Name:LUCKY STARS ADULT DAY HEALTH CARE CENTER, INC
Entity Type:Organization
Organization Name:LUCKY STARS ADULT DAY HEALTH CARE CENTER, INC
Other - Org Name:LUCKY STARS ADHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CCS,
Authorized Official - Phone:909-655-6168
Mailing Address - Street 1:8300 UTICA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3852
Mailing Address - Country:US
Mailing Address - Phone:909-957-9995
Mailing Address - Fax:
Practice Address - Street 1:19715 COLIMA RD UNIT B
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-3211
Practice Address - Country:US
Practice Address - Phone:909-957-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care