Healthcare Provider Details

I. General information

NPI: 1548889140
Provider Name (Legal Business Name): 1570 FAIR OAKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 N FAIR OAKS AVE
PASADENA CA
91103-1822
US

IV. Provider business mailing address

1301 DANA PL
FULLERTON CA
92831-1108
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-0558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ARLENE ROSALES
Title or Position: MANAGING MEMBER
Credential:
Phone: 714-600-6435