Provider Demographics
NPI:1366297855
Name:GALAXY GUEST HOME LLC
Entity type:Organization
Organization Name:GALAXY GUEST HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARALLI-TAMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-247-4879
Mailing Address - Street 1:12802 CURTIS AND KING RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2177
Mailing Address - Country:US
Mailing Address - Phone:949-247-4879
Mailing Address - Fax:
Practice Address - Street 1:12802 CURTIS AND KING RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2177
Practice Address - Country:US
Practice Address - Phone:949-247-4879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility