Provider Demographics
NPI:1326624610
Name:CANYON OAKS ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:CANYON OAKS ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:ACUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-439-3096
Mailing Address - Street 1:1890 E WOODSMAN PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1096
Mailing Address - Country:US
Mailing Address - Phone:480-696-4158
Mailing Address - Fax:
Practice Address - Street 1:1890 E WOODSMAN PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-1096
Practice Address - Country:US
Practice Address - Phone:480-696-4158
Practice Address - Fax:480-625-3156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility