Healthcare Provider Details

I. General information

NPI: 1669162590
Provider Name (Legal Business Name): CAPO BEACH HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35410 DEL REY
CAPISTRANO BEACH CA
92624-1814
US

IV. Provider business mailing address

1801 JULIAN AVE
BAKERSFIELD CA
93304-6419
US

V. Phone/Fax

Practice location:
  • Phone: 949-496-5786
  • Fax:
Mailing address:
  • Phone: 661-831-9150
  • Fax:

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. MOISHE FRANKEL
Title or Position: MANAGER
Credential:
Phone: 323-828-3832