MEDICARE: TEMPLE GARDEN HOMES 5

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	1782137	CA

General Provider Information

NPI Number	:	1366580052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEMPLE GARDEN HOMES 5

Provider Business Mailing Address
First Line	:	5120 BALDWIN AVE
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-3901
Country	:	US
Telephone Number	:	626-444-2836
Fax Number	:	626-444-6090

Provider Business Practice Location Address
First Line	:	10202 GREEN ST
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-3336
Country	:	US
Telephone Number	:	626-455-0677
Fax Number	:	626-401-3259

Authorized Official
Title or Position	:	CEO
Name	:	FLORENCIA PILPA
Credential	:	RN, MS
Telephone Number	:	626-444-2836

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	04/22/2008

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