Healthcare Provider Details

I. General information

NPI: 1568461341
Provider Name (Legal Business Name): CALIFORNIA FRIENDS HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12151 DALE STREET
STANTON CA
90680-3889
US

IV. Provider business mailing address

12151 DALE STREET
STANTON CA
90680-3889
US

V. Phone/Fax

Practice location:
  • Phone: 714-530-9100
  • Fax: 714-530-0945
Mailing address:
  • Phone: 714-530-9100
  • Fax: 714-530-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060000159
License Number StateCA

VIII. Authorized Official

Name: MR. RANDAL J BROWN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 714-530-9100