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General NPI Number Information
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NPI Number | 1245891761
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Entity Type | Organization
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Legal Business Name | THE LIVING ROOM - SENIOR SERVICES
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 9828 VALLE VISTA RD
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City | PHELAN
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State | CA
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Zip | 92371-8431
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Country | US
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Telephone | 760-983-5909
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Fax |
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Provider Business Mailing Address
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Address Line | 9828 VALLE VISTA RD
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City | PHELAN
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State | CA
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Zip | 92371-8431
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Country | US
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Telephone | 760-983-5909
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Fax |
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Authorized Official
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Title or Position | OWNER / DIRECTOR
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Name | SONDRA CRADDUCK
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Credential | BA - GERONTOLOGY
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Telephone | 760-983-5909
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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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