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General NPI Number Information
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NPI Number | 1467500694
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Entity Type | Organization
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Legal Business Name | MT. ZION CARE SPECIALE, LLC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4643 BEVERLY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90004-3101
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Country | US
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Telephone | 323-461-0588
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Fax | 323-461-0432
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Provider Business Mailing Address
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Address Line | 2025 CARLOS ST
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City | ALHAMBRA
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State | CA
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Zip | 91803-4432
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Country | US
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Telephone | 626-864-8854
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Fax | 323-461-0432
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. VIRGINIA SOTELO DOLAR
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Credential | B.S. IN BUSINESS ADM
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Telephone | 626-864-8854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 200318210050
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License Number State | CA
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