Provider Demographics
NPI:1346407871
Name:MATHARU ASSISTED LIVING, INC
Entity Type:Organization
Organization Name:MATHARU ASSISTED LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MATHARU
Authorized Official - Suffix:
Authorized Official - Credentials:MBHM
Authorized Official - Phone:310-328-8482
Mailing Address - Street 1:PO BOX 11261
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-1261
Mailing Address - Country:US
Mailing Address - Phone:310-328-8482
Mailing Address - Fax:310-320-1924
Practice Address - Street 1:2420 W 156TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4616
Practice Address - Country:US
Practice Address - Phone:310-380-6884
Practice Address - Fax:310-320-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities