Healthcare Provider Details

I. General information

NPI: 1255509378
Provider Name (Legal Business Name): WD GATE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 03/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5602 VALLEY GLEN WAY
LOS ANGELES CA
90043-2122
US

IV. Provider business mailing address

5602 VALLEY GLEN WAY
LOS ANGELES CA
90043-2122
US

V. Phone/Fax

Practice location:
  • Phone: 323-295-6744
  • Fax: 323-295-6711
Mailing address:
  • Phone: 323-295-6744
  • Fax: 323-295-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. GAYE GRIFFIN
Title or Position: ADMINISTRATOR
Credential: R.N.
Phone: 323-295-6744