Provider Demographics
NPI:1114059219
Name:CAPISTRANO BEACH CARE CENTER, LLC
Entity Type:Organization
Organization Name:CAPISTRANO BEACH CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALEBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-533-7818
Mailing Address - Street 1:35410 DEL REY
Mailing Address - Street 2:
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-1814
Mailing Address - Country:US
Mailing Address - Phone:949-496-5786
Mailing Address - Fax:949-496-0540
Practice Address - Street 1:35410 DEL REY
Practice Address - Street 2:
Practice Address - City:CAPISTRANO BEACH
Practice Address - State:CA
Practice Address - Zip Code:92624-1814
Practice Address - Country:US
Practice Address - Phone:949-496-5786
Practice Address - Fax:949-496-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05585KMedicaid
CAZZT05585JMedicaid
CAZZT05585KMedicaid