Provider Demographics
NPI:1245444264
Name:SPRING ADULT DAY HEALTH CARE, INC
Entity type:Organization
Organization Name:SPRING ADULT DAY HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:JO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-505-3088
Mailing Address - Street 1:19648 CAMINO DE ROSA
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2103
Mailing Address - Country:US
Mailing Address - Phone:626-965-7833
Mailing Address - Fax:626-964-5483
Practice Address - Street 1:19648 CAMINO DE ROSA
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2103
Practice Address - Country:US
Practice Address - Phone:626-965-7833
Practice Address - Fax:626-964-5483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000934251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060000934Medicaid