Provider Demographics
NPI:1649496407
Name:NEW LIFE ADULT DAY HEALTH CARE CENTER - GARDEN GROVE
Entity type:Organization
Organization Name:NEW LIFE ADULT DAY HEALTH CARE CENTER - GARDEN GROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:WOON
Authorized Official - Last Name:BANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-894-9500
Mailing Address - Street 1:8100 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1016
Mailing Address - Country:US
Mailing Address - Phone:714-894-9500
Mailing Address - Fax:714-894-5580
Practice Address - Street 1:8100 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1016
Practice Address - Country:US
Practice Address - Phone:714-894-9500
Practice Address - Fax:714-894-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70228GMedicaid