MEDICARE: DOROTHY'S DAUGHTER

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	253J00000X	Foster Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1437914918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOROTHY'S DAUGHTER

Provider Business Mailing Address
First Line	:	2181 E FOOTHILL BLVD STE 203
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-6825
Country	:	US
Telephone Number	:	626-298-6135
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 N LAKE AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-1228
Country	:	US
Telephone Number	:	626-298-6135
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOROTHY SIMPSON
Credential	:
Telephone Number	:	626-298-6135

Provider Enumeration Date	:	02/14/2024
Last Update Date	:	02/14/2024

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