Healthcare Provider Details

I. General information

NPI: 1609927268
Provider Name (Legal Business Name): AMADA ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12619 S AVALON BLVD
LOS ANGELES CA
90061-2727
US

IV. Provider business mailing address

12619 S AVALON BLVD
LOS ANGELES CA
90061-2727
US

V. Phone/Fax

Practice location:
  • Phone: 323-757-1881
  • Fax: 323-905-0980
Mailing address:
  • Phone: 323-757-1881
  • Fax: 323-905-0980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number056417
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN E JONES
Title or Position: ADMINISTRATOR
Credential: RPH, MBA, NHA
Phone: 323-757-1881