Healthcare Provider Details

I. General information

NPI: 1881681559
Provider Name (Legal Business Name): 1130 W LA PALMA AVE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2005
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 W LA PALMA AVE
ANAHEIM CA
92801-2803
US

IV. Provider business mailing address

4115 E BROADWAY
LONG BEACH CA
90803-1532
US

V. Phone/Fax

Practice location:
  • Phone: 714-772-7480
  • Fax: 714-776-1841
Mailing address:
  • Phone: 562-930-0777
  • Fax: 562-930-0728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060000227
License Number StateCA

VIII. Authorized Official

Name: MS. ROSALIE PIACENTI SANCHEZ
Title or Position: MANAGER
Credential:
Phone: 562-930-0777