MEDICARE: BAJ MANAGEMENT, 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	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	197603952	CA

General Provider Information

NPI Number	:	1972906584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAJ MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	800 PROSPECT AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-2420
Country	:	US
Telephone Number	:	626-799-1141
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 PROSPECT AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-2420
Country	:	US
Telephone Number	:	626-799-1141
Fax Number	:	626-799-0445

Authorized Official
Title or Position	:	CEO
Name	:	MR. ELI KRICH
Credential	:
Telephone Number	:	213-500-5678

Provider Enumeration Date	:	09/28/2014
Last Update Date	:	09/28/2014

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