Healthcare Provider Details

I. General information

NPI: 1831276302
Provider Name (Legal Business Name): MATHARU ASSISTED LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 ARLINGTON AVE
TORRANCE CA
90501-4439
US

IV. Provider business mailing address

PO BOX 11261
TORRANCE CA
90510-1261
US

V. Phone/Fax

Practice location:
  • Phone: 310-328-8482
  • Fax: 310-320-1924
Mailing address:
  • Phone: 310-328-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. DAVE S. MATHARU
Title or Position: PRESIDENT/CEO
Credential: MBHM
Phone: 310-328-8482