Healthcare Provider Details

I. General information

NPI: 1194002170
Provider Name (Legal Business Name): FOOTHILL RCF, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 SAINT ESTABAN ST
TUJUNGA CA
91042-3335
US

IV. Provider business mailing address

6720 SAINT ESTABAN ST
TUJUNGA CA
91042-3335
US

V. Phone/Fax

Practice location:
  • Phone: 818-353-3350
  • Fax: 818-353-4771
Mailing address:
  • Phone: 818-353-3350
  • Fax: 818-353-4771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number197607570
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number197607570
License Number StateCA

VIII. Authorized Official

Name: MELYN CADABES
Title or Position: DIRECTOR OF FINANCIAL SERVICES
Credential:
Phone: 818-273-8904