Healthcare Provider Details

I. General information

NPI: 1801643838
Provider Name (Legal Business Name): AZALEA MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/11/2024
Certification Date: 05/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1759 WINDERMERE DR
LANCASTER CA
93534-5319
US

IV. Provider business mailing address

1559 ROYWOOD DR
LANCASTER CA
93535-4223
US

V. Phone/Fax

Practice location:
  • Phone: 818-687-3830
  • Fax: 661-949-1304
Mailing address:
  • Phone: 818-687-3830
  • Fax: 661-949-1034

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: MR. ANDERSON BANGIS MUNOZ
Title or Position: CEO
Credential:
Phone: 818-687-3830