Healthcare Provider Details

I. General information

NPI: 1124023403
Provider Name (Legal Business Name): MAYFLOWER GARDENS HEALTH FACILITIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6705 COLUMBIA WAY
LANCASTER CA
93536-1233
US

IV. Provider business mailing address

6705 COLUMBIA WAY
LANCASTER CA
93536-1233
US

V. Phone/Fax

Practice location:
  • Phone: 661-943-3212
  • Fax: 661-943-1303
Mailing address:
  • Phone: 661-943-3212
  • Fax: 661-943-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number920000048
License Number StateCA

VIII. Authorized Official

Name: STUART HARTMAN
Title or Position: V.P. OF OPERATIONS
Credential:
Phone: 562-257-5100