Provider Demographics
NPI:1548458235
Name:ROSENWALD C. ROBERTSON ADULT DAY HEALTH CARE
Entity type:Organization
Organization Name:ROSENWALD C. ROBERTSON ADULT DAY HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MSDT, DPI
Authorized Official - Phone:916-452-2529
Mailing Address - Street 1:3400 ELVAS AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-1913
Mailing Address - Country:US
Mailing Address - Phone:916-452-2529
Mailing Address - Fax:916-452-3129
Practice Address - Street 1:3400 ELVAS AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-1913
Practice Address - Country:US
Practice Address - Phone:916-452-2529
Practice Address - Fax:916-452-3129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REHABILITATION THERAPY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000518261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70075GOtherMEDI-CAL