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General NPI Number Information
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NPI Number | 1790768083
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Entity Type | Organization
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Legal Business Name | ANAHEIM TERRACE CARE CENTER, LLC
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | 141 S. KNOTT AVE.
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City | ANAHEIM
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State | CA
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Zip | 92804-1406
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Country | US
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Telephone | 714-821-7310
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Fax |
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Provider Business Mailing Address
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Address Line | 141 S. KNOTT AVE.
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City | ANAHEIM
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State | CA
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Zip | 92804-1406
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Country | US
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Telephone | 714-821-7310
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Fax |
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | MICHAEL T. BERG
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Credential |
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Telephone | 505-468-4752
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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 | 080000647
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License Number State | CA
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