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General NPI Number Information
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NPI Number | 1205099942
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Entity Type | Organization
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Legal Business Name | D&D MANOR INC.
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 15561 ASHGORVE DRIVE
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City | LA MIRADA
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State | CA
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Zip | 90638
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Country | US
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Telephone | 714-994-3497
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Fax |
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Provider Business Mailing Address
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Address Line | 5419 LORELEI AVE
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City | LAKEWOOD
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State | CA
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Zip | 90712-2036
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Country | US
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Telephone | 562-866-3324
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DOMINGO BERMUDEZ ABARQUEZ
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Credential |
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Telephone | 562-866-3324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 306003493
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License Number State | CA
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