=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285830901
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUNDREY'S RESIDENTIAL CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5740 OSTROM AVE
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316-1406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-758-0196
-----------------------------------------------------
Fax | 818-758-0358
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8335 WINNETKA AVENUE #626
-----------------------------------------------------
City | WINNETKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-585-7956
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. PAULETTE MOSES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-585-7956
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------