Provider Demographics
NPI:1265462436
Name:ITALIAN MAPLE HOLDINGS, LLC
Entity Type:Organization
Organization Name:ITALIAN MAPLE HOLDINGS, LLC
Other - Org Name:LA PALOMA HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-471-0388
Mailing Address - Street 1:3232 THUNDER DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4447
Mailing Address - Country:US
Mailing Address - Phone:760-724-2193
Mailing Address - Fax:760-724-0085
Practice Address - Street 1:3232 THUNDER DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4447
Practice Address - Country:US
Practice Address - Phone:760-724-2193
Practice Address - Fax:760-724-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000100314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265462436Medicaid
CAZZTO5335HMedicaid
CAZZTO5335HMedicaid