Healthcare Provider Details

I. General information

NPI: 1720256944
Provider Name (Legal Business Name): IGID SENIOR CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6631 AVENIDA DE PALOMA
PALMDALE CA
93552-4106
US

IV. Provider business mailing address

37620 SIMI ST
PALMDALE CA
93552-4039
US

V. Phone/Fax

Practice location:
  • Phone: 661-533-3811
  • Fax: 661-533-2036
Mailing address:
  • Phone: 661-533-1627
  • Fax: 661-533-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. FABIOLA PALANGDAO IGID
Title or Position: CHAIRMAN OF THE BOARD
Credential:
Phone: 661-209-2027