Basic Information
| Provider Information | |||||||||
| NPI: | 1295996668 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN FERNANDO VALLEY ADULT DAY HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14558 SYLVAN ST | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914112324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187874151 | ||||||||
| FaxNumber: | 8187872840 | ||||||||
| Practice Location | |||||||||
| Address1: | 10660 WHITE OAK AVE STE C | ||||||||
| Address2: | |||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913445953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187874151 | ||||||||
| FaxNumber: | 8187872840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2008 | ||||||||
| LastUpdateDate: | 06/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | MACIAS | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8187874151 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VAN NUYS ALCOHOL & DRUG TREATMENT CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | B.A. LIBERAL STUDIES | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 190327AP | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.