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General NPI Number Information
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NPI Number | 1710334487
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Entity Type | Organization
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Legal Business Name | GENMAR HOMES, INC.
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 1942 THOREAU ST
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City | LOS ANGELES
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State | CA
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Zip | 90047-4725
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Country | US
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Telephone | 323-755-7105
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Fax | 323-755-7106
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Provider Business Mailing Address
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Address Line | 14901 CONDON AVE
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City | LAWNDALE
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State | CA
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Zip | 90260-1216
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Country | US
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Telephone | 323-755-7105
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Fax | 323-755-7106
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. 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 | 00000
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License Number State | CA
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