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General NPI Number Information
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NPI Number | 1699555334
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Entity Type | Organization
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Legal Business Name | ABUNDANT GRACE CARE VILLA
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 9672 COLONY ST
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City | ANAHEIM
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State | CA
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Zip | 92804-3475
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Country | US
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Telephone | 562-774-6297
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Fax | 562-381-9333
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Provider Business Mailing Address
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Address Line | 13915 FIDLER AVE
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City | BELLFLOWER
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State | CA
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Zip | 90706-2235
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Country | US
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Telephone | 562-774-6297
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Fax | 562-381-9333
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Authorized Official
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Title or Position | LICENSEE/ADMINISTRATOR
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Name | MS. THERESA DOMPREH-MENSAH
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Credential |
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Telephone | 562-774-6297
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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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