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General NPI Number Information
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NPI Number | 1376734087
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Entity Type | Organization
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Legal Business Name | 535 W BROADWAY INC
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 535 W BROADWAY
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City | GLENDALE
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State | CA
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Zip | 91204-1131
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Country | US
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Telephone | 818-246-4951
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Fax | 818-243-0437
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Provider Business Mailing Address
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Address Line | 535 W BROADWAY
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City | GLENDALE
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State | CA
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Zip | 91204-1131
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Country | US
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Telephone | 818-246-4951
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Fax | 818-243-0437
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAUL SOLOMON
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Credential |
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Telephone | 818-246-4951
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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 | 191221839
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License Number State | CA
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