MEDICARE: XYRIS ENTERPRISE INC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1245047059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XYRIS ENTERPRISE INC

Provider Business Mailing Address
First Line	:	PO BOX 7785
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-9185
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28024 CALZADA DR
Second Line	:
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-1227
Country	:	US
Telephone Number	:	310-872-8456
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MUQEET DADABHOY
Credential	:
Telephone Number	:	310-251-2382

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/16/2024

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Directions to “XYRIS ENTERPRISE INC ” Practice Location

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