Healthcare Provider Details

I. General information

NPI: 1437615119
Provider Name (Legal Business Name): PROACTIVE CARE CLHF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40648 13TH ST W
PALMDALE CA
93551-2105
US

IV. Provider business mailing address

40648 13TH ST W
PALMDALE CA
93551-2105
US

V. Phone/Fax

Practice location:
  • Phone: 818-616-2404
  • Fax: 800-730-8558
Mailing address:
  • Phone: 818-616-2404
  • Fax: 800-730-8558

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: MAGGIE BALYAN
Title or Position: CEO
Credential:
Phone: 818-616-2404