=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528441888
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN CARE EXCELLENCE CONGREGATE LIVING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2015
-----------------------------------------------------
Last Update Date | 07/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18620 FRANKFORT ST
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91324-4742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-900-9074
-----------------------------------------------------
Fax | 818-699-1290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9253 RESEDA BLVD
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91324-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-900-9074
-----------------------------------------------------
Fax | 818-699-1290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. JEMAIMA CASTRO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-900-9074
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320700000X
-----------------------------------------------------
Taxonomy Name | Physical Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------