MEDICARE: FAMILY HANDS ADULT RESIDENTIAL CARE, LLC

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	251C00000X	Developmentally Disabled Services Day Training Agency	198601610	CA
2	251C00000X	Developmentally Disabled Services Day Training Agency	198602224	CA
3	251J00000X	Nursing Care Agency	198601610	CA
4	251J00000X	Nursing Care Agency	198602224	CA
5	251S00000X	Community/Behavioral Health Agency	198601610	CA
6	310400000X	Assisted Living Facility	198602224	CA
7	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	198601610	CA
8	177F00000X	Lodging Provider	198602224	CA
9	177F00000X	Lodging Provider	198601610	CA
10	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	198602224	CA
11	315P00000X	Intellectual Disabilities Intermediate Care Facility	198602224	CA
12	315P00000X	Intellectual Disabilities Intermediate Care Facility	198601610	CA

General Provider Information

NPI Number	:	1528569779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HANDS ADULT RESIDENTIAL CARE, LLC

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

Provider Business Practice Location Address
First Line	:	10016 LA SALLE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-4242
Country	:	US
Telephone Number	:	323-754-2151
Fax Number	:	323-754-2151

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. TINA EVETTE SCRUGGS-TATE
Credential	:
Telephone Number	:	323-533-2396

Provider Enumeration Date	:	02/23/2018
Last Update Date	:	06/16/2018

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