Provider Demographics
NPI:1477274520
Name:CANAAN HOME INC.
Entity Type:Organization
Organization Name:CANAAN HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:GARDON
Authorized Official - Last Name:LABSTIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-206-1964
Mailing Address - Street 1:10904 ARIZONA AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5902
Mailing Address - Country:US
Mailing Address - Phone:951-343-9197
Mailing Address - Fax:951-808-7116
Practice Address - Street 1:10904 ARIZONA AVENUE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5902
Practice Address - Country:US
Practice Address - Phone:951-343-9197
Practice Address - Fax:951-808-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility