=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700151156
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALHAMBRA SERVICES CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2012
-----------------------------------------------------
Last Update Date | 03/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1745 N GRAMERCY PL
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90028-5863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-467-3121
-----------------------------------------------------
Fax | 323-469-0627
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1745 N GRAMERCY PL
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90028-5863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-467-3121
-----------------------------------------------------
Fax | 323-469-0627
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. SHAUN D RUSHFORTH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-467-3121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 191800073
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------