Healthcare Provider Details

I. General information

NPI: 1548778152
Provider Name (Legal Business Name): SK MARATHON HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7246 FALLBROOK AVE
WEST HILLS CA
91307
US

IV. Provider business mailing address

7246 FALLBROOK AVE
WEST HILLS CA
91307
US

V. Phone/Fax

Practice location:
  • Phone: 818-912-6757
  • Fax:
Mailing address:
  • Phone: 818-912-6757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number197609055
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: SUN IL KIM
Title or Position: PRESIDENT
Credential:
Phone: 805-200-8100