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General NPI Number Information
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NPI Number | 1881681559
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Entity Type | Organization
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Legal Business Name | 1130 W LA PALMA AVE INC
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Dates
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Enumeration Date | 09/28/2005
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 1130 W LA PALMA AVE
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City | ANAHEIM
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State | CA
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Zip | 92801-2803
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Country | US
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Telephone | 714-772-7480
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Fax | 714-776-1841
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Provider Business Mailing Address
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Address Line | 4115 E BROADWAY
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City | LONG BEACH
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State | CA
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Zip | 90803-1532
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Country | US
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Telephone | 562-930-0777
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Fax | 562-930-0728
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Authorized Official
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Title or Position | MANAGER
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Name | MS. ROSALIE PIACENTI SANCHEZ
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Credential |
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Telephone | 562-930-0777
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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 | 060000227
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License Number State | CA
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