Provider Demographics
NPI:1265946065
Name:3FACES RANCH, LLC
Entity type:Organization
Organization Name:3FACES RANCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:RYKERT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:310-749-3737
Mailing Address - Street 1:2851 W AVENUE L STE 313
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4022
Mailing Address - Country:US
Mailing Address - Phone:661-480-0912
Mailing Address - Fax:
Practice Address - Street 1:2039 W AVENUE M12
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1710
Practice Address - Country:US
Practice Address - Phone:310-749-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197609078253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care