Healthcare Provider Details

I. General information

NPI: 1528049954
Provider Name (Legal Business Name): ATHERTON BAPTIST HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S ATLANTIC BLVD
ALHAMBRA CA
91801-3298
US

IV. Provider business mailing address

214 S ATLANTIC BLVD
ALHAMBRA CA
91801-3298
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-4178
  • Fax: 626-576-0857
Mailing address:
  • Phone: 626-289-4178
  • Fax: 626-576-0857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. DONALD LLOYD SMITH
Title or Position: ADMINISTRATOR
Credential: NHA 3423
Phone: 626-289-4178