1275749715 NPI number — ROBILYN GUEST HOME, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275749715 NPI number — ROBILYN GUEST HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBILYN GUEST HOME, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275749715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2882 MUIR TRAIL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-830-7231
Provider Business Mailing Address Fax Number:
310-830-2581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22237 CATSKILL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARSON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-830-7231
Provider Business Practice Location Address Fax Number:
310-830-2581
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REYNOLDS
Authorized Official First Name:
ERLINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSEE
Authorized Official Telephone Number:
310-830-7231

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  960001054 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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