Healthcare Provider Details

I. General information

NPI: 1598576472
Provider Name (Legal Business Name): LA CADENA MANOR CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2025
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25445 NATIONAL TRAILS HWY
HELENDALE CA
92342-9794
US

IV. Provider business mailing address

PO BOX 154
HELENDALE CA
92342-0154
US

V. Phone/Fax

Practice location:
  • Phone: 760-245-4523
  • Fax: 909-317-2546
Mailing address:
  • Phone: 760-245-4523
  • Fax: 909-317-2546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: MARIA TERESA GARCIA DATUIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 760-245-4523