Organization
MAYFAIR ADULT DAY HEALTH CARE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LYUDMILA PRUDKOV (PRESIDENT)
(323) 766-5363
Entity
Organization
Contact information
Practice address
1627 W 20TH ST, LOS ANGELES, CA 90007-1102
(323) 299-8788
(323) 299-8726
Mailing address
1627 W 20TH ST, LOS ANGELES, CA 90007-1102
(323) 766-5363
(323) 766-5364
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
060000718
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ADU70196F
MEDI-CAL
CA
05
—
ADU70196F
—
CA
Enumeration date
09/20/2006
Last updated
10/08/2013
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