Maxicare Senior Home, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MAXICARE SENIOR HOME, LLC

Practice address

44523 15TH St W
Lancaster, CA 93534-2847

Phone

(818) 846-4469

NPI assigned

Dec 30, 2019

Last updated

Dec 30, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Teodulo BonzonNPI 1497039192

Title

Manager

Phone

(818) 846-4469

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Teodulo Cruz Bonzon, LCSW

  • Clinical Social Worker
  • Glendale, CA
  • NPI 1497039192
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1577664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577664000000",
    "number": "1124667738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3013 ANNITA DR",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912061302",
            "telephone_number": "818-846-4469",
            "fax_number": "818-457-5577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44523 15TH ST W",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935342847",
            "telephone_number": "818-846-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXICARE SENIOR HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-30",
        "last_updated": "2019-12-30",
        "certification_date": "2019-12-30",
        "status": "A",
        "authorized_official_last_name": "BONZON",
        "authorized_official_first_name": "TEODULO",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "818-846-4469"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arron Matthews Sr.
• Marilyn Marcia Matthews, RN
• Nicole Matthews
• Tadra A Matthews
• Crystal Mattson
• Maximum Palliative Care and Hospice, Inc.
• Berna Lee Mayer, RN, MSN, CFNP
• Mayflower Gardens Health Facilities Inc (Mayflower Gardens Convalescent Hospital)
• Diyla Maymoun
• Jaiden Mayo

• Assisted Living Facility in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.