Provider Demographics
NPI:1538859962
Name:MANHATTAN BEACH GUEST HOME, INC.
Entity type:Organization
Organization Name:MANHATTAN BEACH GUEST HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLIOS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:702-290-3235
Mailing Address - Street 1:21221 S WESTERN AVE STE 155
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2983
Mailing Address - Country:US
Mailing Address - Phone:310-533-1131
Mailing Address - Fax:
Practice Address - Street 1:317 S AVIATION BLVD
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-7017
Practice Address - Country:US
Practice Address - Phone:310-533-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility