Provider Demographics
NPI:1356660732
Name:T MICHAEL, LLC
Entity Type:Organization
Organization Name:T MICHAEL, LLC
Other - Org Name:ATWATER VILLAGE NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:COURY
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:323-876-6370
Mailing Address - Street 1:7316 WOODROW WILSON DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-1321
Mailing Address - Country:US
Mailing Address - Phone:323-876-6370
Mailing Address - Fax:323-957-9792
Practice Address - Street 1:4107 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1309
Practice Address - Country:US
Practice Address - Phone:323-876-6370
Practice Address - Fax:323-957-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197602460310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility