=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144491713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAGIDOW RESIDENTIAL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2008
-----------------------------------------------------
Last Update Date | 03/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4010 ARLINGTON AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90008-2712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-293-8444
-----------------------------------------------------
Fax | 323-293-0246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4010 ARLINGTON AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90008-2712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. BIRDIE MAE KING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-293-8444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------