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General NPI Number Information
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NPI Number | 1144070863
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Entity Type | Organization
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Legal Business Name | 9 GEM ENTERPRISES LLC
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 2100 S WESTERN AVE
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City | SAN PEDRO
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State | CA
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Zip | 90732-4331
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Country | US
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Telephone | 310-548-0625
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Fax |
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Provider Business Mailing Address
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Address Line | 445 S FAIR OAKS AVE
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City | PASADENA
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State | CA
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Zip | 91105-2632
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Country | US
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Telephone | 626-304-6900
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Fax | 626-564-2617
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Authorized Official
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Title or Position | COO
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Name | MR. BRAD GIBSON
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Credential |
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Telephone | 323-326-9426
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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 |
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License Number State |
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