Provider Demographics
NPI:1689883712
Name:ARTESIA ADULT DAY HEALTH CARE, INC
Entity Type:Organization
Organization Name:ARTESIA ADULT DAY HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONG HO
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-916-7898
Mailing Address - Street 1:12220 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-7039
Mailing Address - Country:US
Mailing Address - Phone:562-916-7898
Mailing Address - Fax:562-916-7571
Practice Address - Street 1:12220 SOUTH ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-7039
Practice Address - Country:US
Practice Address - Phone:562-916-7898
Practice Address - Fax:562-916-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care