Provider Demographics
NPI:1740477413
Name:ADULT DAY HEALTH CENTERS OF AMERICA, INC.
Entity type:Organization
Organization Name:ADULT DAY HEALTH CENTERS OF AMERICA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHIZHOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-792-8400
Mailing Address - Street 1:PO BOX 17968
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-7968
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2309 S FLOWERS ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007
Practice Address - Country:US
Practice Address - Phone:626-792-8400
Practice Address - Fax:626-799-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000651261QA0600X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70142GOtherADULT DAY HEALTH CARE CEN