Basic Information
| Provider Information | |||||||||
| NPI: | 1982808416 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | D & U LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 824 S GLADYS AVE | ||||||||
| Address2: | |||||||||
| City: | SAN GABRIEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917762710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262870753 | ||||||||
| FaxNumber: | 6262862421 | ||||||||
| Practice Location | |||||||||
| Address1: | 824 S GLADYS AVE | ||||||||
| Address2: | |||||||||
| City: | SAN GABRIEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917762710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262870753 | ||||||||
| FaxNumber: | 6262862421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 01/08/2009 | ||||||||
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| AuthorizedOfficialLastName: | DEMARCO | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
| AuthorizedOfficialMiddleName: | ELIZABETH | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER OF LLC | ||||||||
| AuthorizedOfficialTelephone: | 6262870753 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 197603734 | CA | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 314000000X | 950000071 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.