1770296758 NPI number — HALLMARK SENIOR LIVING LLC

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 1770296758 NPI number — HALLMARK SENIOR LIVING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HALLMARK SENIOR LIVING 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:
Provider Other Organization Name Type Code:
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:
1770296758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
236 S MANSFIELD 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:
90036-3017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-512-3884
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 AKERS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93309-5058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-834-0200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2023

Additional Information

Authorized Official

Authorized Official Last Name:
THURM
Authorized Official First Name:
ZACHARY
Authorized Official Middle Name:
MAX
Authorized Official Title or Position:
LLC MEMBER
Authorized Official Telephone Number:
516-512-3884

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 157209304 . This is a "COMMUNITY CARE LICENSING DIVISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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