Healthcare Provider Details

I. General information

NPI: 1962592683
Provider Name (Legal Business Name): CALIFORNIA FRIENDS HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/21/2007
Certification Date:
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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1211180001
License Number StateCA

VIII. Authorized Official

Name: MISS YOLY VIERNES
Title or Position: MEDICARE BILLER
Credential:
Phone: 714-971-6605