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General NPI Number Information
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NPI Number | 1114361102
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Entity Type | Organization
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Legal Business Name | FONTHILL GARDENS INC
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Dates
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Enumeration Date | 04/22/2013
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 14103 FONTHILL AVE
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City | HAWTHORNE
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State | CA
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Zip | 90250-8013
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Country | US
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Telephone | 310-973-7242
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Fax | 310-973-7147
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Provider Business Mailing Address
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Address Line | 14103 FONTHILL AVE
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City | HAWTHORNE
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State | CA
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Zip | 90250-8013
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Country | US
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Telephone | 310-973-7242
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Fax | 310-973-7147
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Authorized Official
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Title or Position | C.E.O
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Name | DR. RAHMAT HUSSAIN KHAN
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Credential | FACS
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Telephone | 310-873-7242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 198204690
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 198204690
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License Number State | CA
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