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General NPI Number Information
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NPI Number | 1215873088
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Entity Type | Organization
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Legal Business Name | EXECUTIVE RESIDENTIAL SERVICES LLC
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Dates
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Enumeration Date | 04/24/2026
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 856 N WEST ST
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City | ANAHEIM
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State | CA
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Zip | 92801-4302
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Country | US
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Telephone | 949-258-3663
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Fax |
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Provider Business Mailing Address
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Address Line | 856 N WEST ST
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City | ANAHEIM
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State | CA
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Zip | 92801-4302
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Country | US
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Telephone | 949-258-3663
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. GENESIS JOHNSON
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Credential |
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Telephone | 562-230-9589
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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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