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General NPI Number Information
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NPI Number | 1548778152
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Entity Type | Organization
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Legal Business Name | SK MARATHON HOME CARE
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 7246 FALLBROOK AVE
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City | WEST HILLS
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State | CA
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Zip | 91307
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Country | US
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Telephone | 818-912-6757
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Fax |
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Provider Business Mailing Address
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Address Line | 7246 FALLBROOK AVE
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City | WEST HILLS
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State | CA
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Zip | 91307
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Country | US
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Telephone | 818-912-6757
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUN IL KIM
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Credential |
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Telephone | 805-200-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 197609055
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License Number State | CA
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