Healthcare Provider Details

I. General information

NPI: 1609865583
Provider Name (Legal Business Name): CAREHOUSE HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 OLD TUSTIN AVE.
SANTA ANA CA
92705-7810
US

IV. Provider business mailing address

1800 OLD TUSTIN AVE.
SANTA ANA CA
92705-7810
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-4900
  • Fax: 714-542-3325
Mailing address:
  • Phone: 714-835-4900
  • Fax: 714-542-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number080000645
License Number StateCA

VIII. Authorized Official

Name: MICHAEL T. BERG
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 505-468-4752