MEDICARE: CAPO BEACH HEALTHCARE 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1669162590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPO BEACH HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	1801 JULIAN AVE
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93304-6419
Country	:	US
Telephone Number	:	661-831-9150
Fax Number	:

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	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. MOISHE FRANKEL
Credential	:
Telephone Number	:	323-828-3832

Provider Enumeration Date	:	05/12/2023
Last Update Date	:	02/20/2024

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