Healthcare Provider Details

I. General information

NPI: 1477530087
Provider Name (Legal Business Name): C.P.C.H. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10610 OWENSMOUTH AVE
CHATSWORTH CA
91311-2151
US

IV. Provider business mailing address

25910 ACERO STE 350
MISSION VIEJO CA
92691-7908
US

V. Phone/Fax

Practice location:
  • Phone: 818-882-3200
  • Fax:
Mailing address:
  • Phone: 949-441-9258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number920000020
License Number StateCA

VIII. Authorized Official

Name: MARC JOHNSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 949-373-8373