MEDICARE: A.N.A RESIDENTIAL 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1245906627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A.N.A RESIDENTIAL CARE

Provider Business Mailing Address
First Line	:	1046 E LANCASTER BLVD
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93535-2752
Country	:	US
Telephone Number	:	661-949-0151
Fax Number	:	855-631-0360

Provider Business Practice Location Address
First Line	:	1046 EAST LANCASTER BOULEVARD
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93535-2752
Country	:	US
Telephone Number	:	661-949-0151
Fax Number	:	855-631-0360

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	WANDA SMITH
Credential	:
Telephone Number	:	661-992-6371

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	08/17/2021

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