MEDICARE: REESE'S BOARD AND CARE HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	191801299	CA

General Provider Information

NPI Number	:	1205262748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REESE'S BOARD AND CARE HOME

Provider Business Mailing Address
First Line	:	11205 MONITOR AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-1935
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11205 MONITOR AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-1935
Country	:	US
Telephone Number	:	323-566-2421
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATTOR
Name	:	HELEN MOORE
Credential	:
Telephone Number	:	323-566-2421

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	09/16/2013

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