MEDICARE: CAPISTRANO BEACH CARE CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114059219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPISTRANO BEACH CARE CENTER, LLC

Provider Business Mailing Address
First Line	:	35410 DEL REY
Second Line	:
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624-1814
Country	:	US
Telephone Number	:	949-496-5786
Fax Number	:	949-496-0540

Provider Business Practice Location Address
First Line	:	35410 DEL REY
Second Line	:
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624-1814
Country	:	US
Telephone Number	:	949-496-5786
Fax Number	:	949-496-0540

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALIREZA TALEBI
Credential	:
Telephone Number	:	714-533-7818

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	04/07/2008

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