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General NPI Number Information
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NPI Number | 1942220421
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Entity Type | Organization
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Legal Business Name | LAIBCO, LLC
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 14165 PURCHE AVE
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City | GARDENA
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State | CA
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Zip | 90249-2824
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Country | US
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Telephone | 310-323-4570
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Fax | 310-323-4675
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Provider Business Mailing Address
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Address Line | 14165 PURCHE AVE
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City | GARDENA
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State | CA
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Zip | 90249-2824
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Country | US
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Telephone | 310-323-4570
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Fax | 310-323-4675
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MR. ARYEH LAIB GREENSPOON
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Credential | CAL. ADMIN LICENSE
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Telephone | 310-323-4570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 910000073
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License Number State | CA
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