Organization
MARY'S HOUSE
Active
Parent organization
ST. MARY INVESTMENTS, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. MARY INVESTMENTS, INC.
Authorized official
DR. EUGENE HARDIN M.D. (LICENSEE)
(310) 739-3585
Entity
Organization
Contact information
Practice address
14901 CONDON AVE, LAWNDALE, CA 90260-1216
(310) 739-3585
(310) 675-4551
Mailing address
14901 CONDON AVE, LAWNDALE, CA 90260-1216
(310) 739-3585
(310) 675-4551
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
960000992
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
156867995901
MEDI-CAL
CA
Enumeration date
05/17/2007
Last updated
07/03/2008
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