=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881849362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A.L. U.S./SAN GABRIEL SENIOR HOUSING, L.P.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2008
-----------------------------------------------------
Last Update Date | 11/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8332 HUNTINGTON DR
-----------------------------------------------------
City | SAN GABRIEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91775-1038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-292-7800
-----------------------------------------------------
Fax | 626-292-7804
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8332 HUNTINGTON DR
-----------------------------------------------------
City | SAN GABRIEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91775-1038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-292-7800
-----------------------------------------------------
Fax | 626-292-7804
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MONICA PAVELKA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-292-7800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------