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General NPI Number Information
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NPI Number | 1568295822
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Entity Type | Organization
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Legal Business Name | KAELAS HOME FOR ELDERLY
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Dates
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Enumeration Date | 08/22/2024
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 24176 MCCOY RD
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City | LAKE FOREST
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State | CA
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Zip | 92630-3834
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Country | US
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Telephone | 310-308-0925
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Fax |
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Provider Business Mailing Address
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Address Line | 5908 PREMIERE AVE
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City | LAKEWOOD
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State | CA
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Zip | 90712-1315
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Country | US
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Telephone | 310-308-0925
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Fax |
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Authorized Official
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Title or Position | LICENSEE/ADMINISTRATOR
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Name | CZARINA DUMALIANG
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Credential |
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Telephone | 310-308-0925
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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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