Healthcare Provider Details

I. General information

NPI: 1508547811
Provider Name (Legal Business Name): TLT ENDEAVOR, LLC - EUROPEAN CHRISTIAN HOME VI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19208 SHERYL AVE
CERRITOS CA
90703-6622
US

IV. Provider business mailing address

19208 SHERYL AVE
CERRITOS CA
90703-6622
US

V. Phone/Fax

Practice location:
  • Phone: 310-365-1357
  • Fax:
Mailing address:
  • Phone: 310-365-1357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: THOMAS TRICE
Title or Position: LICENSEE
Credential:
Phone: 310-365-1357