Basic Information
| Provider Information | |||||||||
| NPI: | 1265180053 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 4607 EAST CALIFORNIA ABL I OPERATIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11766 WILSHIRE BLVD STE 1460 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900256874 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4607 E CALIFORNIA PKWY | ||||||||
| Address2: | |||||||||
| City: | FOREST HILL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761197571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172478259 | ||||||||
| FaxNumber: | 8175346974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2022 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | ZAMORA | ||||||||
| AuthorizedOfficialFirstName: | EVA | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED REPRESENTATIVE | ||||||||
| AuthorizedOfficialTelephone: | 8063790399 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 02/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.