Healthcare Provider Details

I. General information

NPI: 1225814098
Provider Name (Legal Business Name): TLT ENDEAVOR, LLC - EUROPEAN CHRISTIAN HOME V
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14402 HELWIG AVE
NORWALK CA
90650-5022
US

IV. Provider business mailing address

14402 HELWIG AVE
NORWALK CA
90650-5022
US

V. Phone/Fax

Practice location:
  • Phone: 562-397-2591
  • Fax:
Mailing address:
  • Phone: 562-397-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: THOMAS TRICE
Title or Position: LICENSEE
Credential:
Phone: 562-397-2591