MEDICARE: TAK 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	320700000X	Physical Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1336661057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAK CARE

Provider Business Mailing Address
First Line	:	2280 N GIRASOL AVE
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-2885
Country	:	US
Telephone Number	:	818-416-3724
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 N GIRASOL AVE
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-2885
Country	:	US
Telephone Number	:	818-416-3724
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TATYANA DEKADOKH
Credential	:
Telephone Number	:	818-606-1373

Provider Enumeration Date	:	07/14/2017
Last Update Date	:	07/14/2017

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