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General NPI Number Information
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NPI Number | 1376532051
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Entity Type | Organization
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Legal Business Name | TOWN AND COUNTRY MANOR CHRISTIAN & MISSIONARY ALLIANCE
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 555 E MEMORY LANE
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City | SANTA ANA
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State | CA
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Zip | 92706-1705
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Country | US
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Telephone | 714-547-7581
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Fax | 714-547-0435
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Provider Business Mailing Address
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Address Line | 555 E MEMORY LANE
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City | SANTA ANA
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State | CA
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Zip | 92706-1705
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Country | US
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Telephone | 714-547-7581
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Fax | 714-547-0435
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. ROBERT GOERZEN
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Credential |
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Telephone | 714-547-7581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 060000191
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License Number State | CA
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Taxonomy #2
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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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