MEDICARE: MAGIDOW RESIDENTIAL CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility		CA

General Provider Information

NPI Number	:	1144491713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGIDOW RESIDENTIAL CARE

Provider Business Mailing Address
First Line	:	4010 ARLINGTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-2712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4010 ARLINGTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-2712
Country	:	US
Telephone Number	:	323-293-8444
Fax Number	:	323-293-0246

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. BIRDIE MAE KING
Credential	:
Telephone Number	:	323-293-8444

Provider Enumeration Date	:	03/21/2008
Last Update Date	:	03/21/2008

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Directions to “MAGIDOW RESIDENTIAL CARE ” Practice Location

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