Provider Demographics
NPI:1750750550
Name:CORAL OAKS CARE LIVING, INC
Entity type:Organization
Organization Name:CORAL OAKS CARE LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:SONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-763-4881
Mailing Address - Street 1:4271 CARLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-5334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:310-763-3881
Practice Address - Street 1:4271 CARLIN AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-5334
Practice Address - Country:US
Practice Address - Phone:310-763-4881
Practice Address - Fax:310-763-3881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility