=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821486630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 4MPW, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2014
-----------------------------------------------------
Last Update Date | 09/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23232 PERALTA DRIVE 216
-----------------------------------------------------
City | LAGUAN HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-610-5910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6412 MEADOW CREST DRIVE
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-213-3164
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. LOWELL HARLAN JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-213-3164
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------