Healthcare Provider Details

I. General information

NPI: 1912835638
Provider Name (Legal Business Name): TITAN SAND PLUM HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9999 E 121ST ST S
BIXBY OK
74008-2551
US

IV. Provider business mailing address

840 APOLLO ST STE 100
EL SEGUNDO CA
90245-4641
US

V. Phone/Fax

Practice location:
  • Phone: 310-725-0120
  • Fax:
Mailing address:
  • Phone:
  • 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: KEVIN KASEFF
Title or Position: MANAGER
Credential:
Phone: 310-725-0120