Healthcare Provider Details

I. General information

NPI: 1285467654
Provider Name (Legal Business Name): YOUR TRAVEL COORDINATORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 EILEEN AVE
LOS ANGELES CA
90043-2256
US

IV. Provider business mailing address

335 E ALBERTONI ST STE 200-609
CARSON CA
90746-1425
US

V. Phone/Fax

Practice location:
  • Phone: 323-792-4156
  • Fax: 877-427-4238
Mailing address:
  • Phone: 562-489-4279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. RICKA THOMAS
Title or Position: OWNER/ ARF ADMINISTRATOR
Credential:
Phone: 562-489-4279