Healthcare Provider Details

I. General information

NPI: 1942220421
Provider Name (Legal Business Name): LAIBCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14165 PURCHE AVE
GARDENA CA
90249-2824
US

IV. Provider business mailing address

14165 PURCHE AVE
GARDENA CA
90249-2824
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-4570
  • Fax: 310-323-4675
Mailing address:
  • Phone: 310-323-4570
  • Fax: 310-323-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number910000073
License Number StateCA

VIII. Authorized Official

Name: MR. ARYEH LAIB GREENSPOON
Title or Position: OWNER/ADMINISTRATOR
Credential: CAL. ADMIN LICENSE
Phone: 310-323-4570