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General NPI Number Information
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NPI Number | 1972999357
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Entity Type | Organization
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Legal Business Name | SPARK FAMILY OPERATIONS, LLC
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 8717 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-1907
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Country | US
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Telephone | 310-659-4301
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Fax | 310-659-7562
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Provider Business Mailing Address
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Address Line | 8717 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-1907
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Country | US
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Telephone | 310-659-4301
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Fax | 310-659-7562
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SUNG NAM PARK
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Credential |
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Telephone | 310-770-0538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 197608842
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License Number State | CA
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