Provider Demographics
NPI:1548332117
Name:MARLINDA IMPERIAL, LLC
Entity type:Organization
Organization Name:MARLINDA IMPERIAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASSOUMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-638-6691
Mailing Address - Street 1:150 BELLEFONTAINE ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3102
Mailing Address - Country:US
Mailing Address - Phone:626-796-1103
Mailing Address - Fax:
Practice Address - Street 1:150 BELLEFONTAINE ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3102
Practice Address - Country:US
Practice Address - Phone:626-796-1103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06080GMedicaid
CAZZT06080GMedicaid