Provider Demographics
NPI:1831670462
Name:OPICA ADULT DAY CARE CENTER, INC.
Entity Type:Organization
Organization Name:OPICA ADULT DAY CARE CENTER, INC.
Other - Org Name:OPICA ADULT DAY PROGRAM & COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHLOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-478-0226
Mailing Address - Street 1:11759 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1865
Mailing Address - Country:US
Mailing Address - Phone:310-478-0226
Mailing Address - Fax:310-478-2026
Practice Address - Street 1:11759 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1865
Practice Address - Country:US
Practice Address - Phone:310-478-0226
Practice Address - Fax:310-478-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191603551261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA191603551OtherCOMMUNITY CARE LICENSING