MEDICARE: HOMES FOR LIFE FOUNDATION

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		CA

General Provider Information

NPI Number	:	1437287489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMES FOR LIFE FOUNDATION

Provider Business Mailing Address
First Line	:	83 BRIARWOOD LN
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-2963
Country	:	US
Telephone Number	:	949-305-3947
Fax Number	:

Provider Business Practice Location Address
First Line	:	8939 S SEPULVEDA BLVD
Second Line	:	SUITE NUMBER 460
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3631
Country	:	US
Telephone Number	:	310-337-7417
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR AND FACILITY ADM
Name	:	MRS. CAROL M LIESS
Credential	:
Telephone Number	:	310-337-7417

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	08/22/2020

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Directions to “HOMES FOR LIFE FOUNDATION ” Practice Location

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