Provider Demographics
NPI:1144201724
Name:CANYON PROPERTIES, INC.
Entity Type:Organization
Organization Name:CANYON PROPERTIES, INC.
Other - Org Name:GOOD SHEPHERD CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:818-896-5391
Mailing Address - Street 1:11505 KAGEL CANYON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:91342-7240
Mailing Address - Country:US
Mailing Address - Phone:818-896-5391
Mailing Address - Fax:818-899-5867
Practice Address - Street 1:11505 KAGEL CANYON ST
Practice Address - Street 2:
Practice Address - City:LAKE VIEW TERRACE
Practice Address - State:CA
Practice Address - Zip Code:91342-7240
Practice Address - Country:US
Practice Address - Phone:818-896-5391
Practice Address - Fax:818-899-5867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55097EMedicaid
CALTC55097EMedicaid