MEDICARE: MATHARU ASSISTED LIVING, INC.

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		CA

General Provider Information

NPI Number	:	1831276302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATHARU ASSISTED LIVING, INC.

Provider Business Mailing Address
First Line	:	PO BOX 11261
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90510-1261
Country	:	US
Telephone Number	:	310-328-8482
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 ARLINGTON AVE
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-4439
Country	:	US
Telephone Number	:	310-328-8482
Fax Number	:	310-320-1924

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. DAVE S. MATHARU
Credential	:	MBHM
Telephone Number	:	310-328-8482

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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