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General NPI Number Information
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NPI Number | 1437367653
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Entity Type | Organization
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Legal Business Name | JASMINE CENTERS, INC. - BEACH AVENUE HOUSE
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Dates
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Enumeration Date | 05/19/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 3846 CHANSON DR
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City | LOS ANGELES
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State | CA
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Zip | 90043-1602
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Country | US
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Telephone | 310-674-8345
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Fax | 310-674-8282
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Provider Business Mailing Address
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Address Line | 105 S PRAIRIE AVE
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City | INGLEWOOD
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State | CA
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Zip | 90301-1969
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Country | US
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Telephone | 310-674-8345
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Fax | 310-674-8282
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Authorized Official
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Title or Position | LICENSEE
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Name | FAYE WILLIAMS
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Credential |
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Telephone | 310-674-8345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 960000566
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License Number State | CA
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