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General NPI Number Information
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NPI Number | 1154610871
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Entity Type | Organization
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Legal Business Name | LOL, CORP
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 4132 KATELLA AVE SUITE 101-9
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3426
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Country | US
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Telephone | 562-430-9845
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Fax | 562-430-9857
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Provider Business Mailing Address
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Address Line | 4132 KATELLA AVE SUITE 101-9
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3426
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Country | US
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Telephone | 562-430-9845
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Fax | 562-430-9857
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Authorized Official
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Title or Position | OWNER
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Name | LILA BASCOM
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Credential |
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Telephone | 562-430-9845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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