MEDICARE: TOWN AND COUNTRY MANOR CHRISTIAN & MISSIONARY ALLIANCE

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	060000191	CA
2	314000000X	Skilled Nursing Facility

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	:	1376532051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN AND COUNTRY MANOR CHRISTIAN & MISSIONARY ALLIANCE

Provider Business Mailing Address
First Line	:	555 E MEMORY LANE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92706-1705
Country	:	US
Telephone Number	:	714-547-7581
Fax Number	:	714-547-0435

Provider Business Practice Location Address
First Line	:	555 E MEMORY LANE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92706-1705
Country	:	US
Telephone Number	:	714-547-7581
Fax Number	:	714-547-0435

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. ROBERT GOERZEN
Credential	:
Telephone Number	:	714-547-7581

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	11/14/2024

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Directions to “TOWN AND COUNTRY MANOR CHRISTIAN & MISSIONARY ALLIANCE ” Practice Location

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