Provider Demographics
NPI:1114335254
Name:CANBY RETIREMENT CORPORATION
Entity Type:Organization
Organization Name:CANBY RETIREMENT CORPORATION
Other - Org Name:AMBASSADOR GARDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-522-4402
Mailing Address - Street 1:7324 CANBY AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3010
Mailing Address - Country:US
Mailing Address - Phone:818-705-3404
Mailing Address - Fax:
Practice Address - Street 1:7324 CANBY AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3010
Practice Address - Country:US
Practice Address - Phone:818-705-3404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197603652310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility