Provider Demographics
NPI:1568295822
Name:KAELAS HOME FOR ELDERLY
Entity type:Organization
Organization Name:KAELAS HOME FOR ELDERLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CZARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMALIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-308-0925
Mailing Address - Street 1:5908 PREMIERE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1315
Mailing Address - Country:US
Mailing Address - Phone:310-308-0925
Mailing Address - Fax:
Practice Address - Street 1:24176 MCCOY RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3834
Practice Address - Country:US
Practice Address - Phone:310-308-0925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility