=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376084475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARDU INC DBA VISITING ANGELS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2017
-----------------------------------------------------
Last Update Date | 03/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3655 TORRANCE BLVD FL 3
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90503-4857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-772-6604
-----------------------------------------------------
Fax | 424-247-1257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3655 TORRANCE BLVD FL 3
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90503-4857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-772-6604
-----------------------------------------------------
Fax | 424-247-1257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JOYCE BARNEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 424-772-6604
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 194700020
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------