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General NPI Number Information
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NPI Number | 1134960081
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Entity Type | Organization
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Legal Business Name | ARCHER RESIDENTIAL CARE INC
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 421 S ARCHER ST
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City | ANAHEIM
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State | CA
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Zip | 92804-2419
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Country | US
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Telephone | 949-682-5229
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Fax |
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Provider Business Mailing Address
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Address Line | 421 S ARCHER ST
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City | ANAHEIM
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State | CA
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Zip | 92804-2419
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LACY FADDOUL
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Credential |
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Telephone | 661-810-7293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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