Provider Demographics
NPI:1952090912
Name:SOUTHWOODS LIVING, INC.
Entity Type:Organization
Organization Name:SOUTHWOODS LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CINCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-525-8552
Mailing Address - Street 1:23506 CLEARPOOL PL
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-1111
Mailing Address - Country:US
Mailing Address - Phone:424-250-9123
Mailing Address - Fax:213-529-0774
Practice Address - Street 1:23506 CLEARPOOL PL
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-1111
Practice Address - Country:US
Practice Address - Phone:424-250-9123
Practice Address - Fax:213-529-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility