=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558848663
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRUDENT COMFORT HOMES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2018
-----------------------------------------------------
Last Update Date | 07/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 902 N CEDAR ST
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90302-2012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-964-4782
-----------------------------------------------------
Fax | 424-227-8596
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 902 N CEDAR ST
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90302-2012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-964-4782
-----------------------------------------------------
Fax | 424-227-8596
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | DORIS TERESA BELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 562-964-4782
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 306004426
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number | 306004426
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------