CANYON HOME III
Intermediate Care Facility, Mental Illness
Shadow Hills, California
Provider NPI: 1669527941
Organization Information:Organization Name: CANYON HOME III
Practice Location:
10712 ARTRUDE ST SHADOW HILLS, CA 91040 US
Tel: 818-353-1514 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
10712 ARTRUDE ST SHADOW HILLS, CA 91040 US
Tel: 818-353-1514 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 310500000X | Nursing & Custodial Care Facilities Intermediate Care Facility, Mental Illness | CA |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
LTC60886F | CA | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin