MEDICARE: OGDEN HOME CORP.

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	261QD1600X	Developmental Disabilities Clinic/Center	191800521	CA

General Provider Information

NPI Number	:	1780843425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OGDEN HOME CORP.

Provider Business Mailing Address
First Line	:	906 N OGDEN DR
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-7310
Country	:	US
Telephone Number	:	323-650-6588
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 N OGDEN DR
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-7310
Country	:	US
Telephone Number	:	323-650-6588
Fax Number	:

Authorized Official
Title or Position	:	ADM.
Name	:	MR. ALLEN SAMSON
Credential	:
Telephone Number	:	323-650-6588

Provider Enumeration Date	:	06/06/2008
Last Update Date	:	06/06/2008

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