MEDICARE: JASMINE CENTERS, INC.

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	960000533	CA

General Provider Information

NPI Number	:	1346458569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASMINE CENTERS, INC.

Provider Business Mailing Address
First Line	:	105 S PRAIRIE AVE
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90301-1969
Country	:	US
Telephone Number	:	310-674-8345
Fax Number	:	310-674-8282

Provider Business Practice Location Address
First Line	:	3846 CHANSON DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-1602
Country	:	US
Telephone Number	:	310-674-8345
Fax Number	:	310-674-8282

Authorized Official
Title or Position	:	LICENSEE
Name	:	FAYE WILLIAMS
Credential	:
Telephone Number	:	310-674-8345

Provider Enumeration Date	:	05/19/2007
Last Update Date	:	06/20/2008

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