Provider Demographics
NPI:1558017111
Name:ALTHAEA MANOR CARE LLC
Entity Type:Organization
Organization Name:ALTHAEA MANOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-961-1303
Mailing Address - Street 1:27172 GOLDEN FIELD CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4538
Mailing Address - Country:US
Mailing Address - Phone:951-961-1303
Mailing Address - Fax:
Practice Address - Street 1:13213 NAPA VALLEY CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-2498
Practice Address - Country:US
Practice Address - Phone:951-379-1429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility