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General NPI Number Information
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NPI Number | 1548038409
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Entity Type | Organization
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Legal Business Name | TLT CARE HAVEN LLC
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 980 FLAMINGO WAY
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City | LA HABRA
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State | CA
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Zip | 90631-3369
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Country | US
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Telephone | 310-365-1357
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Fax | 562-239-2479
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Provider Business Mailing Address
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Address Line | 980 FLAMINGO WAY # 22
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City | LA HABRA
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State | CA
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Zip | 90631-3369
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Country | US
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Telephone | 310-365-1357
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Fax | 562-239-2479
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Authorized Official
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Title or Position | CFO
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Name | LIZA TRICE
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Credential |
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Telephone | 310-365-1357
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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 |
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License Number State |
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