1689870024 NPI number — LANCASTER ADULT DAY HEALTH CARE

Table of content: (NPI 1689870024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689870024 NPI number — LANCASTER ADULT DAY HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANCASTER ADULT DAY HEALTH CARE
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:
Provider Other Organization Name Type Code:
6
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:
1689870024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45104 10TH STREET WEST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-942-2391
Provider Business Mailing Address Fax Number:
661-902-6839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
858 W. JACKMAN
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-948-1228
Provider Business Practice Location Address Fax Number:
661-948-8109
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COOK
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
C.E.O.
Authorized Official Telephone Number:
661-942-2391

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X , with the licence number: 060000691 , 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: ADU70254G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CMCSUBKMN , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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