Healthcare Provider Details

I. General information

NPI: 1679572929
Provider Name (Legal Business Name): HACIENDA POST ACUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 E GRANGEVILLE BLVD
HANFORD CA
93230-3054
US

IV. Provider business mailing address

1440 S STATE COLLEGE BLVD SUITE 2A
ANAHEIM CA
92806-5724
US

V. Phone/Fax

Practice location:
  • Phone: 559-582-9221
  • Fax: 559-582-8955
Mailing address:
  • Phone: 714-778-0221
  • Fax: 714-778-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number040000101
License Number StateCA

VIII. Authorized Official

Name: MRS. DONNA F STOTTS
Title or Position: VICE PRESIDENT
Credential:
Phone: 714-778-0221