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General NPI Number Information
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NPI Number | 1083084651
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Entity Type | Organization
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Legal Business Name | CHARDE ANTOINETTE
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Dates
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Enumeration Date | 09/25/2015
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 2923 W 138TH
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City | GARDENA
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State | CA
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Zip | 90249
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Country | US
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Telephone | 213-798-1547
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 W CENTURY BLVD UNIT 47758
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City | LOS ANGELES
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State | CA
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Zip | 90047
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Country | US
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Telephone | 213-798-1547
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHARDE PETRUS
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Credential | LVN
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Telephone | 213-798-1547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | VN228125
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License Number State | CA
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