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General NPI Number Information
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NPI Number | 1073997946
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Entity Type | Organization
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Legal Business Name | DEE'S GROUP HOME INC
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 2721 W 84TH PL
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City | INGLEWOOD
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State | CA
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Zip | 90305-1807
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Country | US
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Telephone | 323-752-1467
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Fax |
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Provider Business Mailing Address
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Address Line | 941 WEST 77TH STREET
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City | LOS ANGELES
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State | CA
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Zip | 90044
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Country | US
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Telephone | 323-752-8358
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Fax | 323-778-8776
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. DELORES JOHNSON
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Credential | R.N.
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Telephone | 323-752-1467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 191801439
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License Number State | CA
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