MEDICARE: LORETO HOLDINGS, LLC

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	310400000X	Assisted Living Facility	197607596	CA

General Provider Information

NPI Number	:	1366992331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORETO HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	2211 W 6TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3120
Country	:	US
Telephone Number	:	213-380-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 W 6TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3120
Country	:	US
Telephone Number	:	213-380-7000
Fax Number	:

Authorized Official
Title or Position	:	FINANCIAL MANAGER
Name	:	JAMES FRANKEL
Credential	:
Telephone Number	:	323-791-3564

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	10/13/2016

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