Healthcare Provider Details

I. General information

NPI: 1134513948
Provider Name (Legal Business Name): 23801 NEWHALL AVENUE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23801 NEWHALL AVE
NEWHALL CA
91321-3126
US

IV. Provider business mailing address

23801 NEWHALL AVE
NEWHALL CA
91321-3126
US

V. Phone/Fax

Practice location:
  • Phone: 661-259-3660
  • Fax:
Mailing address:
  • Phone: 661-259-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number920000051
License Number StateCA

VIII. Authorized Official

Name: MR. HENRY KIM
Title or Position: MANAGER
Credential:
Phone: 562-587-9092