Organization · NPI-2

126th Street Homes, INC. - Loop Home I

Intermediate Care Facility, Intellectual Disabilities · Hawthorne, CA

NPI number1013125228
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1013125228
Entity type
Organization (NPI-2)
Legal business name
126th Street Homes, INC. - Loop Home I
Organization subpart
No
Enumeration date
May 19, 2007
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
315P00000X Intermediate Care Facility, Intellectual Disabilities960001085CAYes

Practice location

4180 W 126th St
Hawthorne, CA 90250-4547

Phone 310-676-7634 · Fax 310-808-0883

Mailing address

15920 S Dalton Ave
Gardena, CA 90247-3908

Phone 310-808-0883 · Fax 310-808-0883

Authorized official

Tony Dojcinovic
Licensee
3108080883

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