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General NPI Number Information
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NPI Number | 1174986939
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Entity Type | Organization
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Legal Business Name | DOMART BOARD AND CARE
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 03/30/2016
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Provider Practice Location Address
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Address Line | 13817 DOMART AVE
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City | NORWALK
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State | CA
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Zip | 90650-3428
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Country | US
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Telephone | 562-484-9134
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Fax | 562-484-9134
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Provider Business Mailing Address
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Address Line | 13817 DOMART AVE
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City | NORWALK
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State | CA
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Zip | 90650-3428
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Country | US
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Telephone | 562-484-9134
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Fax | 562-484-9134
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Authorized Official
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Title or Position | LICENSEE/ OWNER
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Name | EMMA TERESITA LU
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Credential |
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Telephone | 562-229-2781
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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 | 198601875
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License Number State | CA
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