Provider Demographics
NPI:1518131861
Name:WEST PALMDALE MANOR
Entity Type:Organization
Organization Name:WEST PALMDALE MANOR
Other - Org Name:WEST PALMDALE MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSEE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-609-4503
Mailing Address - Street 1:38982 JUNIPER TREE RD
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5414
Mailing Address - Country:US
Mailing Address - Phone:661-609-4503
Mailing Address - Fax:661-267-1310
Practice Address - Street 1:38982 JUNIPER TREE RD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-5414
Practice Address - Country:US
Practice Address - Phone:661-266-3179
Practice Address - Fax:661-267-1310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST PALMDALE MANOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility