Healthcare Provider Details

I. General information

NPI: 1255786448
Provider Name (Legal Business Name): K'S LOVING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N AMELIA ST
ANAHEIM CA
92807
US

IV. Provider business mailing address

1211 N AMELIA ST
ANAHEIM CA
92807
US

V. Phone/Fax

Practice location:
  • Phone: 714-803-4399
  • Fax:
Mailing address:
  • Phone: 714-803-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number306004126
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number306001456
License Number StateCA

VIII. Authorized Official

Name: MR. EYOB KEBEDE
Title or Position: VICE PRESIDENT
Credential:
Phone: 714-803-4399