NPIMap

Organization Active NPI

Jacky & Angie Residential Care

  • Adult Care Home Facility
  • Bellflower, CA
National Provider Identifier
1174880066
Registry record updated Apr 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
304006088 Issued in CA
Legal business name
JACKY & ANGIE RESIDENTIAL CARE
Practice address
9332 Greenwell St
Bellflower, CA 90706-3411
Phone
(310) 613-4211
NPI assigned
Apr 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2012

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

Authorized official

Name
Mrs. Evangeline B Johnson
Title
Adminstratrator
Phone
(562) 925-7527

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X 304006088 CA Primary

Addresses

Primary practice location

9332 Greenwell St
Bellflower, CA 90706-3411

Mailing address

9332 Greenwell Street
Bellflower, CA 90706
Phone (310) 613-4211

National Provider Directory

National Provider Directory
Tax ID family
Angie Residential Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1334534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334534400000",
    "number": "1174880066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9332 GREENWELL STREET",
            "city": "BELLFLOWER",
            "state": "CA",
            "postal_code": "90706",
            "telephone_number": "310-613-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9332 GREENWELL ST",
            "city": "BELLFLOWER",
            "state": "CA",
            "postal_code": "907063411",
            "telephone_number": "310-613-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKY & ANGIE RESIDENTIAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-16",
        "last_updated": "2012-04-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "EVANGELINE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ADMINSTRATRATOR",
        "authorized_official_telephone_number": "562-925-7527",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "CA",
            "license": "304006088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellflower, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2012; 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.