1669645636 NPI number — QUANTUM ADULT DAY HEALTH CARE CENTER

Table of content: (NPI 1669645636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669645636 NPI number — QUANTUM ADULT DAY HEALTH CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUANTUM ADULT DAY HEALTH CARE CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PROMISE HOSPITAL OF SAN DIEGO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669645636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
999 YAMATO ROAD
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-869-3100
Provider Business Mailing Address Fax Number:
561-826-0171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5550 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-2307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-582-3800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ARMSTRONG
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EVP/GENERAL COUNSEL
Authorized Official Telephone Number:
561-869-3100

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  090000105 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ADU70363G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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