Healthcare Provider Details

I. General information

NPI: 1285119230
Provider Name (Legal Business Name): DOCRD L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 01/03/2021
Certification Date: 01/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 IVAR AVE
LOS ANGELES CA
90028-5008
US

IV. Provider business mailing address

PO BOX 1138
LOS ANGELES CA
90078-1138
US

V. Phone/Fax

Practice location:
  • Phone: 213-700-2661
  • Fax:
Mailing address:
  • Phone: 213-700-2661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL TODD GREENE
Title or Position: OWNER CEO
Credential: ED.D., M.S., R.D.N.
Phone: 213-700-2661