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General NPI Number Information
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NPI Number | 1801608062
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Entity Type | Organization
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Legal Business Name | GEORGETOWN LOVING HOME LLC
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Dates
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Enumeration Date | 01/24/2025
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 11592 VICILIA ST
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City | GARDEN GROVE
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State | CA
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Zip | 92841-1911
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Country | US
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Telephone | 714-867-6576
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Fax |
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Provider Business Mailing Address
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Address Line | 5961 STANTON AVE
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City | BUENA PARK
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State | CA
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Zip | 90621-2145
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Country | US
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Telephone | 714-760-2560
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Fax |
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Authorized Official
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Title or Position | LLC MEMBER
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Name | EVELYN G BRIONES
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Credential |
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Telephone | 714-760-2560
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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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