Healthcare Provider Details

I. General information

NPI: 1447791959
Provider Name (Legal Business Name): RETIREMENT HOUSING FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N STUDEBAKER RD
LONG BEACH CA
90815-4900
US

IV. Provider business mailing address

911 N STUDEBAKER RD
LONG BEACH CA
90815-4900
US

V. Phone/Fax

Practice location:
  • Phone: 562-257-5100
  • Fax: 562-493-3413
Mailing address:
  • Phone: 562-257-5100
  • Fax: 562-493-3413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberBU200027420
License Number StateCA

VIII. Authorized Official

Name: MR. LAVERNE R. JOSEPH
Title or Position: PRESIDENT / CEO
Credential: M.D.
Phone: 562-257-5100