Healthcare Provider Details

I. General information

NPI: 1790015063
Provider Name (Legal Business Name): IN HONOR OF OUR PARENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 W 40TH PL
LOS ANGELES CA
90037-1802
US

IV. Provider business mailing address

1133 W 40TH PL
LOS ANGELES CA
90037-1802
US

V. Phone/Fax

Practice location:
  • Phone: 323-296-7816
  • Fax: 323-296-7816
Mailing address:
  • Phone: 323-296-7816
  • Fax: 323-296-7816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number197607238
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number197607238
License Number StateCA

VIII. Authorized Official

Name: MS. ANGELA DENISE LOVE
Title or Position: LICENSEE/ADMINISTRATOR
Credential:
Phone: 562-805-8799