Healthcare Provider Details

I. General information

NPI: 1740275486
Provider Name (Legal Business Name): 1440 SOUTH EUCLID ST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 S EUCLID ST
ANAHEIM CA
92802-2156
US

IV. Provider business mailing address

1440 S EUCLID ST
ANAHEIM CA
92802-2156
US

V. Phone/Fax

Practice location:
  • Phone: 714-535-7264
  • Fax: 714-535-0940
Mailing address:
  • Phone: 714-535-7264
  • Fax: 714-535-0940

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: CAROLINE L BOYER
Title or Position: DIRECTOR OF PATIENT ACCOUNTING
Credential:
Phone: 818-367-9546