Provider Demographics
NPI:1689870024
Name:LANCASTER ADULT DAY HEALTH CARE
Entity Type:Organization
Organization Name:LANCASTER ADULT DAY HEALTH CARE
Other - Org Name:LANCASTER ADULT DAY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-942-2391
Mailing Address - Street 1:45104 10TH STREET WEST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-942-2391
Mailing Address - Fax:661-902-6839
Practice Address - Street 1:858 W. JACKMAN
Practice Address - Street 2:SUITE #101
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-948-1228
Practice Address - Fax:661-948-8109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANTELOPE VALLEY COMMUNITY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-22
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
CA060000691261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70254GMedicaid
CACMCSUBKMNMedicaid