Provider Demographics
NPI:1154610871
Name:LOL, CORP
Entity type:Organization
Organization Name:LOL, CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-430-9845
Mailing Address - Street 1:4132 KATELLA AVE
Mailing Address - Street 2:SUITE 101-9
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3426
Mailing Address - Country:US
Mailing Address - Phone:562-430-9845
Mailing Address - Fax:562-430-9857
Practice Address - Street 1:4132 KATELLA AVE
Practice Address - Street 2:SUITE 101-9
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3426
Practice Address - Country:US
Practice Address - Phone:562-430-9845
Practice Address - Fax:562-430-9857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care