=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598576472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA CADENA MANOR CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2025
-----------------------------------------------------
Last Update Date | 01/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25445 NATIONAL TRAILS HWY
-----------------------------------------------------
City | HELENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92342-9794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-245-4523
-----------------------------------------------------
Fax | 909-317-2546
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 154
-----------------------------------------------------
City | HELENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92342-0154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-245-4523
-----------------------------------------------------
Fax | 909-317-2546
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MARIA TERESA GARCIA DATUIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-245-4523
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311500000X
-----------------------------------------------------
Taxonomy Name | Alzheimer Center (Dementia Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 315D00000X
-----------------------------------------------------
Taxonomy Name | Inpatient Hospice
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------