Provider Demographics
NPI:1114361102
Name:FONTHILL GARDENS INC
Entity Type:Organization
Organization Name:FONTHILL GARDENS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHMAT
Authorized Official - Middle Name:HUSSAIN
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:FACS
Authorized Official - Phone:310-873-7242
Mailing Address - Street 1:14103 FONTHILL AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-8013
Mailing Address - Country:US
Mailing Address - Phone:310-973-7242
Mailing Address - Fax:310-973-7147
Practice Address - Street 1:14103 FONTHILL AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-8013
Practice Address - Country:US
Practice Address - Phone:310-973-7242
Practice Address - Fax:310-973-7147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1982046903104A0625X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility