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General NPI Number Information
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NPI Number | 1891078119
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Entity Type | Organization
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Legal Business Name | FALKS FAMILY HOME
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 15431 GARO ST
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-2704
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Country | US
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Telephone | 626-336-3484
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Fax |
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Provider Business Mailing Address
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Address Line | 15431 GARO ST
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-2704
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Country | US
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Telephone | 626-336-3484
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MAGDALENA N FALK
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Credential |
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Telephone | 626-336-3484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 197801493
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License Number State | CA
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