MEDICARE: WEST ANAHEIM EXTENDED CARE

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	314000000X	Skilled Nursing Facility	060000255	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

General Provider Information

NPI Number	:	1235235300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST ANAHEIM EXTENDED CARE

Provider Business Mailing Address
First Line	:	645 S BEACH BLVD
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3102
Country	:	US
Telephone Number	:	714-821-1993
Fax Number	:	714-821-8450

Provider Business Practice Location Address
First Line	:	645 S BEACH BLVD
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3102
Country	:	US
Telephone Number	:	714-821-1993
Fax Number	:	714-821-8450

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	VICTORIA LLAMADO
Credential	:
Telephone Number	:	714-821-1993

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	08/27/2015

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