Provider Demographics
NPI:1881687176
Name:ACACIA ADULT DAY SERVICES
Entity Type:Organization
Organization Name:ACACIA ADULT DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-530-1566
Mailing Address - Street 1:11391 ACACIA PKWY
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5310
Mailing Address - Country:US
Mailing Address - Phone:714-530-1566
Mailing Address - Fax:714-530-1592
Practice Address - Street 1:11391 ACACIA PKWY
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5310
Practice Address - Country:US
Practice Address - Phone:714-530-1566
Practice Address - Fax:714-530-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000363261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70087FOtherMEDI-CAL PROVIDER NUMBER