Provider Demographics
NPI:1003374059
Name:COMPASSIONATE HOME CONGREGATE FACILITY LLC
Entity Type:Organization
Organization Name:COMPASSIONATE HOME CONGREGATE FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR OF NURSING
Authorized Official - Prefix:MR
Authorized Official - First Name:LAMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:VALIENTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:800-811-3151
Mailing Address - Street 1:1457 S NUTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-6067
Mailing Address - Country:US
Mailing Address - Phone:800-811-3151
Mailing Address - Fax:800-811-5942
Practice Address - Street 1:1457 S NUTWOOD ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-6067
Practice Address - Country:US
Practice Address - Phone:800-811-3151
Practice Address - Fax:800-811-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility