=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538385729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAILEY CARE HOMES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 11/29/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9811 S DENKER AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90047-3965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-754-7874
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23120 ALICIA PKWY STE 200
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92692-1212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-439-0880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SHAWN BAILEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-293-8722
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------