Provider Demographics
NPI:1871705020
Name:BE WELL ADULT DAY HEALTH CARE, INC.
Entity type:Organization
Organization Name:BE WELL ADULT DAY HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MOLCHANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-837-8285
Mailing Address - Street 1:10925 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1511
Mailing Address - Country:US
Mailing Address - Phone:818-837-8285
Mailing Address - Fax:818-837-8245
Practice Address - Street 1:10925 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1511
Practice Address - Country:US
Practice Address - Phone:818-837-8285
Practice Address - Fax:818-837-8245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care