Healthcare Provider Details

I. General information

NPI: 1780665356
Provider Name (Legal Business Name): GERI-CARE V, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44445 15TH ST W
LANCASTER CA
93534-2801
US

IV. Provider business mailing address

44445 15TH ST W
LANCASTER CA
93534-2801
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-7501
  • Fax: 661-949-5498
Mailing address:
  • Phone: 661-948-7501
  • Fax: 661-949-5498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number920000003
License Number StateCA

VIII. Authorized Official

Name: MRS. MARIA DONNA B SANTOS
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 661-948-7501