Provider Demographics
NPI:1568231371
Name:ANAHEIM PALACE
Entity Type:Organization
Organization Name:ANAHEIM PALACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-252-7287
Mailing Address - Street 1:525 W LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2432
Mailing Address - Country:US
Mailing Address - Phone:626-252-7287
Mailing Address - Fax:
Practice Address - Street 1:525 W LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2432
Practice Address - Country:US
Practice Address - Phone:626-252-7287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANAHEIM PALACE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility