Provider Demographics
NPI:1265180053
Name:4607 EAST CALIFORNIA ABL I OPERATIONS LLC
Entity type:Organization
Organization Name:4607 EAST CALIFORNIA ABL I OPERATIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:E
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:817-475-3521
Mailing Address - Street 1:11766 WILSHIRE BLVD STE 1460
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6874
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4607 E CALIFORNIA PKWY
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76119-7571
Practice Address - Country:US
Practice Address - Phone:817-247-8259
Practice Address - Fax:817-534-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility