Provider Demographics
NPI:1780843425
Name:OGDEN HOME CORP.
Entity Type:Organization
Organization Name:OGDEN HOME CORP.
Other - Org Name:OGDEN MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADM.
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-650-6588
Mailing Address - Street 1:906 N OGDEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-7310
Mailing Address - Country:US
Mailing Address - Phone:323-650-6588
Mailing Address - Fax:
Practice Address - Street 1:906 N OGDEN DR
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-7310
Practice Address - Country:US
Practice Address - Phone:323-650-6588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191800521261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities