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General NPI Number Information
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NPI Number | 1295248623
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Entity Type | Organization
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Legal Business Name | TLC GUEST HOME, INC
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 1700 248TH ST
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City | LOMITA
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State | CA
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Zip | 90717-1333
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Country | US
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Telephone | 424-263-5385
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Fax |
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Provider Business Mailing Address
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Address Line | 733 W CARSON ST
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City | TORRANCE
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State | CA
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Zip | 90502-2106
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Country | US
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Telephone | 702-502-7632
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Fax | 702-359-2388
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARY ALYN ABAD DOMONDON
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Credential | DIRECTOR
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Telephone | 424-263-5385
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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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