Provider Demographics
NPI:1942397161
Name:LUIS G CENDANA
Entity Type:Organization
Organization Name:LUIS G CENDANA
Other - Org Name:K AND S GROUP HOME 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIVINA
Authorized Official - Middle Name:PASAPORTE
Authorized Official - Last Name:CENDANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-634-9251
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 1:1503 254TH ST
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2716
Practice Address - Country:US
Practice Address - Phone:310-326-0374
Practice Address - Fax:310-517-4843
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA320600000XMedicaid