Healthcare Provider Details

I. General information

NPI: 1003374059
Provider Name (Legal Business Name): COMPASSIONATE HOME CONGREGATE FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1457 S NUTWOOD ST
ANAHEIM CA
92804-6067
US

IV. Provider business mailing address

1457 S NUTWOOD ST
ANAHEIM CA
92804-6067
US

V. Phone/Fax

Practice location:
  • Phone: 800-811-3151
  • Fax: 800-811-5942
Mailing address:
  • Phone: 800-811-3151
  • Fax: 800-811-5942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. LAMBERTO VALIENTE JR.
Title or Position: ADMINISTRATOR/DIRECTOR OF NURSING
Credential: RN
Phone: 800-811-3151