Provider Demographics
NPI:1679660898
Name:K AND S GROUP HOME 11 INC
Entity Type:Organization
Organization Name:K AND S GROUP HOME 11 INC
Other - Org Name:LUIS CENDANA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIVINA
Authorized Official - Middle Name:PASAPORTE
Authorized Official - Last Name:CENDANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-326-0374
Mailing Address - Street 1:1503 254TH ST
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2716
Mailing Address - Country:US
Mailing Address - Phone:310-326-0374
Mailing Address - Fax:310-517-4843
Practice Address - Street 1:22008 RASHDALL AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2916
Practice Address - Country:US
Practice Address - Phone:310-834-3644
Practice Address - Fax:310-834-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities