Provider Demographics
NPI:1336138999
Name:HOLIDAY MANOR CARE CENTER
Entity Type:Organization
Organization Name:HOLIDAY MANOR CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTORIO
Authorized Official - Middle Name:OCBENA
Authorized Official - Last Name:SOSING
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:818-341-9800
Mailing Address - Street 1:20554 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1746
Mailing Address - Country:US
Mailing Address - Phone:818-341-9800
Mailing Address - Fax:818-341-1925
Practice Address - Street 1:20554 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91306-1746
Practice Address - Country:US
Practice Address - Phone:818-341-9800
Practice Address - Fax:818-341-1925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
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
CAZZT18160GMedicaid
CA555578Medicare ID - Type Unspecified