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General NPI Number Information
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NPI Number | 1154260693
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Entity Type | Organization
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Legal Business Name | CLUB RANCHO MANOR INC
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Dates
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Enumeration Date | 03/27/2026
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Last Update Date | 03/27/2026
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Provider Practice Location Address
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Address Line | 3618 CLUB RANCHO DR
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City | PALMDALE
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State | CA
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Zip | 93551-5652
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Country | US
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Telephone | 818-332-6150
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Fax |
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Provider Business Mailing Address
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Address Line | 1716 ERRINGER RD STE 106
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City | SIMI VALLEY
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State | CA
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Zip | 93065-6527
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Country | US
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Telephone | 818-332-6150
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Fax |
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Authorized Official
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Title or Position | LICENSEE
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Name | MR. JEROME DELA CRUZ VIRAY
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Credential |
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Telephone | 818-332-6150
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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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