Basic Information
| Provider Information | |||||||||
| NPI: | 1801099734 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ON LOK SENIOR HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 BUSH ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941095611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152928888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4430 MISSION ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941121927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153372858 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MARUYAMA | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR CEO | ||||||||
| AuthorizedOfficialTelephone: | 4152928880 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | 070000489 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
ID Information
| ID | Type | State | Issuer | Description | ADU 70425F | 05 | CA | MEDICAID |