Provider Demographics
NPI:1437615119
Name:PROACTIVE CARE CLHF
Entity Type:Organization
Organization Name:PROACTIVE CARE CLHF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-616-2404
Mailing Address - Street 1:40648 13TH ST W
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-2105
Mailing Address - Country:US
Mailing Address - Phone:818-616-2404
Mailing Address - Fax:800-730-8558
Practice Address - Street 1:40648 13TH ST W
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-2105
Practice Address - Country:US
Practice Address - Phone:818-616-2404
Practice Address - Fax:800-730-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility