1528569779 NPI number — FAMILY HANDS ADULT RESIDENTIAL CARE, LLC

Table of content: (NPI 1528569779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528569779 NPI number — FAMILY HANDS ADULT RESIDENTIAL CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HANDS ADULT RESIDENTIAL CARE, LLC
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:
FAMILY HANDS ADULT CARE FACILITY
Provider Other Organization Name Type Code:
3
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:
1528569779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10016 LA SALLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90047-4242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-533-2396
Provider Business Mailing Address Fax Number:
323-571-9769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10016 LA SALLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90047-4242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-754-2151
Provider Business Practice Location Address Fax Number:
323-754-2151
Provider Enumeration Date:
02/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SCRUGGS-TATE
Authorized Official First Name:
TINA
Authorized Official Middle Name:
EVETTE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
323-533-2396

Provider Taxonomy Codes

  • Taxonomy code: 177F00000X , with the licence number:  198601610 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 177F00000X , with the licence number: 198602224 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X , with the licence number: 198601610 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X , with the licence number: 198602224 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: 198601610 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: 198602224 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 198601610 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 198602224 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3104A0630X , with the licence number: 198601610 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3104A0630X , with the licence number: 198602224 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: 198601610 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 315P00000X , with the licence number: 198602224 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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