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General NPI Number Information
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NPI Number | 1821255258
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Entity Type | Organization
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Legal Business Name | STAR ICF/DD-N WAKEFIELD HOME
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 14621 WAKEFIELD ST
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City | WESTMINSTER
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State | CA
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Zip | 92683-5718
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Country | US
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Telephone | 562-400-1503
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Fax | 174-183-9863
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Provider Business Mailing Address
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Address Line | 14621 WAKEFIELD ST
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City | WESTMINSTER
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State | CA
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Zip | 92683-5718
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Country | US
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Telephone | 562-400-1503
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Fax | 174-183-9863
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. LIZA DARADAR DE LOS ANGELES
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Credential | RN
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Telephone | 562-400-1503
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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 | 550000699
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License Number State | CA
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