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General NPI Number Information
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NPI Number | 1710570924
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Entity Type | Organization
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Legal Business Name | ACL LLC
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Dates
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Enumeration Date | 02/18/2021
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 473 E. CARNEGIE DRIVE, # 200
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City | SAN BERNARDINO
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State | CA
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Zip | 92408
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Country | US
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Telephone | 909-836-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 402 N SIESTA AVE
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City | LA PUENTE
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State | CA
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Zip | 91746-2015
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Country | US
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Telephone | 909-836-8200
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | CHRISTIAN DE GUZMAN
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Credential |
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Telephone | 909-836-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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