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General NPI Number Information
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NPI Number | 1326288325
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Entity Type | Organization
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Legal Business Name | JADE HEALING RETREAT
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 10740 WILSHIRE BLVD STE 921
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City | LOS ANGELES
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State | CA
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Zip | 90024-4493
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Country | US
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Telephone | 310-557-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 10740 WILSHIRE BLVD STE 921
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City | LOS ANGELES
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State | CA
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Zip | 90024-4493
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COLEEN A TUNNEY
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Credential |
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Telephone | 310-733-6161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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