Healthcare Provider Details

I. General information

NPI: 1528569779
Provider Name (Legal Business Name): FAMILY HANDS ADULT RESIDENTIAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10016 LA SALLE AVE
LOS ANGELES CA
90047-4242
US

IV. Provider business mailing address

10016 LA SALLE AVE
LOS ANGELES CA
90047-4242
US

V. Phone/Fax

Practice location:
  • Phone: 323-754-2151
  • Fax: 323-754-2151
Mailing address:
  • Phone: 323-533-2396
  • Fax: 323-571-9769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number198601610
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number198602224
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number198601610
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number198602224
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number198601610
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number198602224
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number198601610
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number198602224
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number198601610
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number198602224
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number198602224
License Number StateCA
# 12
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number198601610
License Number StateCA

VIII. Authorized Official

Name: MRS. TINA EVETTE SCRUGGS-TATE
Title or Position: ADMINISTRATOR
Credential:
Phone: 323-533-2396