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General NPI Number Information
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NPI Number | 1255164604
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Entity Type | Organization
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Legal Business Name | ATHENA HEALTH PROFESSIONAL
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Dates
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Enumeration Date | 08/21/2024
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 4651 FORMOSA WAY
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City | PERRIS
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State | CA
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Zip | 92571-5119
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Country | US
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Telephone | 213-840-7660
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Fax |
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Provider Business Mailing Address
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Address Line | 5117 E TANGO CIR
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City | ANAHEIM
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State | CA
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Zip | 92807-1206
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Country | US
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Telephone | 213-840-7660
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MS. DANNA LYN SANTIAGO
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Credential |
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Telephone | 213-840-7660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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