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NPI Code Detail

MEDICARE: HACIENDA C H INC

MEDICARE: HACIENDA C H INC
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
1314000000XSkilled Nursing Facility940000084CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922083435
Entity Type Code : Organization
Provider Name (Legal Business Name) : HACIENDA C H INC
Provider Business Mailing Address
First Line : 25910 ACERO STE 350
Second Line :
City : MISSION VIEJO
State : CA
Zip : 92691-7908
Country : US
Telephone Number : 949-441-9258
Fax Number :
Provider Business Practice Location Address
First Line : 2725 E BROADWAY
Second Line :
City : LONG BEACH
State : CA
Zip : 90803-5431
Country : US
Telephone Number : 562-434-4494
Fax Number :
Authorized Official
Title or Position : CFO
Name : MARC JOHNSON
Credential :
Telephone Number : 949-373-8373
Provider Enumeration Date : 12/07/2005
Last Update Date : 04/05/2024

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Directions to “HACIENDA C H INC ” Practice Location

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