=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134294275
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LANMC CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1920 S ROBERTSON BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90034-1129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-559-9144
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9808 VENICE BLVD 706
-----------------------------------------------------
City | CULVER CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90232-2732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-839-3200
-----------------------------------------------------
Fax | 310-839-1247
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | AMNON LICHT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-839-3200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------