MEDICARE: AZALEA MANOR

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	:	1801643838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZALEA MANOR

Provider Business Mailing Address
First Line	:	1559 ROYWOOD DR
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93535-4223
Country	:	US
Telephone Number	:	818-687-3830
Fax Number	:	661-949-1034

Provider Business Practice Location Address
First Line	:	1759 WINDERMERE DR
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-5319
Country	:	US
Telephone Number	:	818-687-3830
Fax Number	:	661-949-1304

Authorized Official
Title or Position	:	CEO
Name	:	MR. ANDERSON BANGIS MUNOZ
Credential	:
Telephone Number	:	818-687-3830

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	05/11/2024

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Directions to “AZALEA MANOR ” Practice Location

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