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General NPI Number Information
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NPI Number | 1851803431
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Entity Type | Organization
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Legal Business Name | LAKEWOOD RESIDENTIAL CARE, LLC
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 11/03/2017
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Provider Practice Location Address
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Address Line | 12045 LAKEWOOD BLVD
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City | DOWNEY
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State | CA
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Zip | 90242-2635
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Country | US
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Telephone | 562-923-4417
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Fax | 562-923-3167
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Provider Business Mailing Address
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Address Line | 12045 LAKEWOOD BLVD
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City | DOWNEY
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State | CA
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Zip | 90242-2635
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Country | US
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Telephone | 562-923-4417
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Fax | 562-923-3167
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Authorized Official
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Title or Position | MANAGER
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Name | ADAM ZENOU
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Credential |
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Telephone | 310-857-8218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State | CA
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