Provider Demographics
NPI:1467125757
Name:GARDEN GROVE GUEST HOME LLC
Entity Type:Organization
Organization Name:GARDEN GROVE GUEST HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YEHUDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-806-0786
Mailing Address - Street 1:12882 SHACKELFORD LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-5109
Mailing Address - Country:US
Mailing Address - Phone:323-806-0786
Mailing Address - Fax:
Practice Address - Street 1:12882 SHACKELFORD LN
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-5109
Practice Address - Country:US
Practice Address - Phone:323-806-0786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility