Provider Demographics
NPI:1215793930
Name:PHAMILY HOME TWILIGHT CARE LLC DBA PHAMILY HOME ELDERLY CARE 3
Entity type:Organization
Organization Name:PHAMILY HOME TWILIGHT CARE LLC DBA PHAMILY HOME ELDERLY CARE 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-724-9930
Mailing Address - Street 1:700 S JANSS ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4503
Mailing Address - Country:US
Mailing Address - Phone:657-772-4993
Mailing Address - Fax:
Practice Address - Street 1:700 S JANSS ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4503
Practice Address - Country:US
Practice Address - Phone:657-772-4993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility