Healthcare Provider Details

I. General information

NPI: 1912575416
Provider Name (Legal Business Name): MRS. THERESA DOMPREH-MENSAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 E 2ND AVE
LA HABRA CA
90631-0820
US

IV. Provider business mailing address

561 E 2ND AVE
LA HABRA CA
90631-0820
US

V. Phone/Fax

Practice location:
  • Phone: 562-774-6297
  • Fax:
Mailing address:
  • Phone: 562-774-6297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number306005743
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number306005743
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number306005743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: