Provider Demographics
NPI:1508074717
Name:GM HOME, INC. - III
Entity Type:Organization
Organization Name:GM HOME, INC. - III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-631-4157
Mailing Address - Street 1:15406 OLIVE BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2430
Mailing Address - Country:US
Mailing Address - Phone:562-631-4157
Mailing Address - Fax:562-352-0046
Practice Address - Street 1:15803 FOSTER RD
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-3119
Practice Address - Country:US
Practice Address - Phone:562-690-1238
Practice Address - Fax:562-352-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities