MEDICARE: FORT FAITH HOME 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1730057357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT FAITH HOME CARE

Provider Business Mailing Address
First Line	:	735 LACONIA BLVD APT 7
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-7008
Country	:	US
Telephone Number	:	323-537-5428
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 LACONIA PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-4083
Country	:	US
Telephone Number	:	323-537-5428
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NISHA FORT
Credential	:
Telephone Number	:	213-362-8837

Provider Enumeration Date	:	10/27/2025
Last Update Date	:	11/29/2025

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