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

Organization subpart

No

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

Authorized official

Name

Teodulo Bonzon

Title

Manager

Phone

(818) 846-4469

Specialties & licenses 1

Addresses

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": []
}

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• 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.