Healthcare Provider Details

I. General information

NPI: 1699813402
Provider Name (Legal Business Name): TEMPLE GARDEN HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 N AVENUE 47
LOS ANGELES CA
90042-1613
US

IV. Provider business mailing address

5120 BALDWIN AVE
TEMPLE CITY CA
91780-3901
US

V. Phone/Fax

Practice location:
  • Phone: 323-254-6991
  • Fax: 323-257-7458
Mailing address:
  • Phone: 626-444-2836
  • Fax: 626-444-6090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number960000931
License Number StateCA

VIII. Authorized Official

Name: FLORENCIA I. PILPA
Title or Position: CEO
Credential: RN, MS
Phone: 626-444-2836