Provider Demographics
NPI:1669715769
Name:58500 VENTURES INC
Entity type:Organization
Organization Name:58500 VENTURES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-569-0600
Mailing Address - Street 1:2892 N BELLFLOWER BLVD
Mailing Address - Street 2:SUITE 492
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1125
Mailing Address - Country:US
Mailing Address - Phone:562-343-5500
Mailing Address - Fax:562-342-6229
Practice Address - Street 1:2792 N BELLFLOWER BLVD
Practice Address - Street 2:SUITE 210A
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815
Practice Address - Country:US
Practice Address - Phone:562-343-5500
Practice Address - Fax:562-342-6229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care