Provider Demographics
NPI:1528569779
Name:FAMILY HANDS ADULT RESIDENTIAL CARE, LLC
Entity Type:Organization
Organization Name:FAMILY HANDS ADULT RESIDENTIAL CARE, LLC
Other - Org Name:FAMILY HANDS ADULT CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:SCRUGGS-TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-533-2396
Mailing Address - Street 1:10016 LA SALLE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-4242
Mailing Address - Country:US
Mailing Address - Phone:323-533-2396
Mailing Address - Fax:323-571-9769
Practice Address - Street 1:10016 LA SALLE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-4242
Practice Address - Country:US
Practice Address - Phone:323-754-2151
Practice Address - Fax:323-754-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198601610177F00000X, 251C00000X, 251J00000X, 251S00000X, 3104A0630X, 315P00000X
CA198602224177F00000X, 251C00000X, 251J00000X, 310400000X, 3104A0630X, 315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No177F00000XOther Service ProvidersLodging
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances