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General NPI Number Information
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NPI Number | 1689998544
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Entity Type | Organization
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Legal Business Name | HOLY TRINITY HOME
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Dates
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Enumeration Date | 03/22/2010
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Last Update Date | 03/22/2010
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Provider Practice Location Address
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Address Line | 3845 S MORGANFIELD AVE
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City | WEST COVINA
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State | CA
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Zip | 91792-3238
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Country | US
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Telephone | 999-444-5796
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Fax | 909-612-7675
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Provider Business Mailing Address
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Address Line | 3845 S MORGANFIELD AVE
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City | WEST COVINA
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State | CA
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Zip | 91792-3238
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Country | US
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Telephone | 999-444-5796
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Fax | 909-612-7675
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Authorized Official
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Title or Position | OWNER/QMRP
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Name | MRS. LYDIA SISON SEBASTIAN
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Credential | RN
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Telephone | 909-444-5796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | CA
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