Provider Demographics
NPI:1164681136
Name:MVM HOME
Entity Type:Organization
Organization Name:MVM HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE QMRP
Authorized Official - Prefix:
Authorized Official - First Name:ROSENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-522-0125
Mailing Address - Street 1:607 E 228TH ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-4907
Mailing Address - Country:US
Mailing Address - Phone:310-522-0125
Mailing Address - Fax:370-518-5178
Practice Address - Street 1:607 E 228TH ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-4907
Practice Address - Country:US
Practice Address - Phone:310-522-0125
Practice Address - Fax:370-518-5178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960001035315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities