Organization
JOMI BROADMOOR ICFDDN
Active
Other names
JOMI ICFDDN
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROGER V CUEVAS (BUSINESS MANAGER)
(818) 841-1044
Entity
Organization
Contact information
Practice address
1547 S BROADMOOR AVE, WEST COVINA, CA 91790-4709
(626) 917-1833
(818) 841-4403
Mailing address
1849 AYERS WAY, BURBANK, CA 91501-1106
(818) 841-1044
(818) 841-4403
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
CA
Other
Enumeration date
02/09/2007
Last updated
08/22/2020
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