=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194002170
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOOTHILL RCF, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2011
-----------------------------------------------------
Last Update Date | 11/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6720 SAINT ESTABAN ST
-----------------------------------------------------
City | TUJUNGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91042-3335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-353-3350
-----------------------------------------------------
Fax | 818-353-4771
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6720 SAINT ESTABAN ST
-----------------------------------------------------
City | TUJUNGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91042-3335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-353-3350
-----------------------------------------------------
Fax | 818-353-4771
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF FINANCIAL SERVICES
-----------------------------------------------------
Name | MELYN CADABES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-273-8904
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311500000X
-----------------------------------------------------
Taxonomy Name | Alzheimer Center (Dementia Center)
-----------------------------------------------------
License Number | 197607570
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 197607570
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------