Provider Demographics
NPI:1083689848
Name:HUMANGOOD SOCAL
Entity Type:Organization
Organization Name:HUMANGOOD SOCAL
Other - Org Name:ROYAL OAKS MANOR - BRADBURY OAKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-924-7115
Mailing Address - Street 1:516 BURCHETT STREET
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1014
Mailing Address - Country:US
Mailing Address - Phone:818-247-0420
Mailing Address - Fax:818-247-3871
Practice Address - Street 1:1763 ROYAL OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:BRADBURY
Practice Address - State:CA
Practice Address - Zip Code:91010
Practice Address - Country:US
Practice Address - Phone:626-359-9371
Practice Address - Fax:626-358-6588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950000121314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55503FMedicaid
CA555503Medicare Oscar/Certification