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General NPI Number Information
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NPI Number | 1669689048
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Entity Type | Organization
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Legal Business Name | IDEAL HOME CARE
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4830 W 130TH ST
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City | HAWTHORNE
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State | CA
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Zip | 90250-5010
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Country | US
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Telephone | 310-973-8266
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Fax | 310-675-8760
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Provider Business Mailing Address
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Address Line | 4000 W 139TH ST
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City | HAWTHORNE
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State | CA
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Zip | 90250-7304
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Country | US
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Telephone | 310-739-3585
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Fax | 310-377-9508
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Authorized Official
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Title or Position | LICENSEE
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Name | EUGENE HARDIN
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Credential | M.D.
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Telephone | 310-739-3585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State | CA
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