Healthcare Provider Details

I. General information

NPI: 1144201724
Provider Name (Legal Business Name): CANYON PROPERTIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11505 KAGEL CANYON ST
LAKE VIEW TERRACE CA
91342-7240
US

IV. Provider business mailing address

11505 KAGEL CANYON ST
LAKE VIEW TERRACE CA
91342-7240
US

V. Phone/Fax

Practice location:
  • Phone: 818-896-5391
  • Fax: 818-899-5867
Mailing address:
  • Phone: 818-896-5391
  • Fax: 818-899-5867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS SUSAN R TOLAND
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 818-896-5391