Healthcare Provider Details

I. General information

NPI: 1578133807
Provider Name (Legal Business Name): MISSION CARMICHAEL POST ACUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 MISSION AVE
CARMICHAEL CA
95608-2933
US

IV. Provider business mailing address

3050 SATURN ST STE 201
BREA CA
92821-6278
US

V. Phone/Fax

Practice location:
  • Phone: 916-488-1580
  • Fax:
Mailing address:
  • Phone: 714-577-3880
  • Fax: 714-577-3895

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: DAVID JOHNSON
Title or Position: CEO
Credential:
Phone: 310-266-1080