Healthcare Provider Details

I. General information

NPI: 1114652617
Provider Name (Legal Business Name): LAKE FOREST POST ACUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25652 OLD TRABUCO RD
LAKE FOREST CA
92630-2776
US

IV. Provider business mailing address

25652 OLD TRABUCO RD
LAKE FOREST CA
92630-2776
US

V. Phone/Fax

Practice location:
  • Phone: 949-380-9380
  • Fax:
Mailing address:
  • Phone: 949-380-9380
  • 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: DAVID JOHNSON
Title or Position: CEO
Credential:
Phone: 714-577-3880