MEDICARE: SAINT BENEDICT CARE 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	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	306005478	OTHER	CA	CCLD-FACILITY NUMBER

General Provider Information

NPI Number	:	1902464753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT BENEDICT CARE LLC

Provider Business Mailing Address
First Line	:	8925 CANARY AVE
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-6324
Country	:	US
Telephone Number	:	657-845-4355
Fax Number	:

Provider Business Practice Location Address
First Line	:	8925 CANARY AVE
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-6324
Country	:	US
Telephone Number	:	657-845-4355
Fax Number	:	714-982-3433

Authorized Official
Title or Position	:	LICENSEE/ADMINISTRATOR
Name	:	MR. ULDARICO BANAGAN ALMIRANEZ
Credential	:
Telephone Number	:	949-290-6006

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/05/2019

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Directions to “SAINT BENEDICT CARE LLC ” Practice Location

Language	Start Address	Practice Location

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