Healthcare Provider Details

I. General information

NPI: 1871101196
Provider Name (Legal Business Name): GREAT HORIZONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 03/27/2022
Certification Date: 03/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17127 PIONEER BLVD STE S
ARTESIA CA
90701-2757
US

IV. Provider business mailing address

17127 PIONEER BLVD STE S
ARTESIA CA
90701-2757
US

V. Phone/Fax

Practice location:
  • Phone: 562-526-8036
  • Fax: 562-526-8027
Mailing address:
  • Phone: 562-526-8036
  • Fax: 562-526-8027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRENCE LOVELESS
Title or Position: CEO/MANAGER
Credential:
Phone: 562-526-8036