Provider Demographics
NPI:1467481630
Name:WINDSOR TWIN PALMS HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:WINDSOR TWIN PALMS HEALTHCARE CENTER, LLC
Other - Org Name:WINDSOR PALMS CARE CENTER OF ARTESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-865-0271
Mailing Address - Street 1:11900 ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-4039
Mailing Address - Country:US
Mailing Address - Phone:562-865-0271
Mailing Address - Fax:
Practice Address - Street 1:11900 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-4039
Practice Address - Country:US
Practice Address - Phone:562-865-0271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA940000166314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT18526GMedicaid
CA555565Medicare ID - Type Unspecified