Provider Demographics
NPI:1609476589
Name:SOUTHBAY CARE HOME, INC.
Entity Type:Organization
Organization Name:SOUTHBAY CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHALANI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-621-9090
Mailing Address - Street 1:350 N GLENDALE AVE
Mailing Address - Street 2:SUITE B # 326
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3794
Mailing Address - Country:US
Mailing Address - Phone:818-621-9090
Mailing Address - Fax:
Practice Address - Street 1:19917 ANZA AVENUE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-2005
Practice Address - Country:US
Practice Address - Phone:310-370-9613
Practice Address - Fax:310-370-9617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility