Healthcare Provider Details

I. General information

NPI: 1932600954
Provider Name (Legal Business Name): ALDERBROOK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2018
Last Update Date: 08/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 W AVENUE K
LANCASTER CA
93536
US

IV. Provider business mailing address

1810 W AVENUE L4
LANCASTER CA
93534-6953
US

V. Phone/Fax

Practice location:
  • Phone: 661-609-9190
  • Fax:
Mailing address:
  • Phone: 661-723-0201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number550004324
License Number StateCA

VIII. Authorized Official

Name: KRISTIN BOYD
Title or Position: CEO
Credential: RN
Phone: 661-609-9190