Healthcare Provider Details

I. General information

NPI: 1538377742
Provider Name (Legal Business Name): MVM HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16230 S ORCHARD AVE
GARDENA CA
90247-5034
US

IV. Provider business mailing address

15920 S DALTON AVE
GARDENA CA
90247-3908
US

V. Phone/Fax

Practice location:
  • Phone: 310-767-1461
  • Fax: 310-808-8803
Mailing address:
  • Phone: 310-808-0883
  • Fax: 310-808-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number960001366
License Number StateCA

VIII. Authorized Official

Name: TONY DOJCINOVIC
Title or Position: LICENSEE
Credential:
Phone: 310-808-0883