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General NPI Number Information
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NPI Number | 1336442870
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Entity Type | Organization
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Legal Business Name | EMERALD ISLE ASSISTED LIVING, INC.
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 27781 HAWTHORNE BLVD
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-3401
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Country | US
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Telephone | 310-351-7075
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Fax | 310-373-5338
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Provider Business Mailing Address
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Address Line | 520 PALOS VERDES BLVD
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City | REDONDO BEACH
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State | CA
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Zip | 90277-6515
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Country | US
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Telephone | 310-378-2270
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Fax | 310-373-5338
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAURA DAWN MARTZ
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Credential |
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Telephone | 310-378-2270
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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 | 198201753
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 198202539
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License Number State | CA
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