MEDICARE: GENERATIONS OF ANAHEIM ASSISTED LIVING FACILITY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1942973029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONS OF ANAHEIM ASSISTED LIVING FACILITY INC

Provider Business Mailing Address
First Line	:	6101 BALL RD STE 208
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-3965
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1941 E CENTER ST
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92805-3409
Country	:	US
Telephone Number	:	714-533-3640
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KYLE WATANABE
Credential	:
Telephone Number	:	213-326-9208

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	07/26/2021

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