Provider Demographics
NPI:1568457299
Name:3067 ORANGE AVENUE LLC
Entity Type:Organization
Organization Name:3067 ORANGE AVENUE LLC
Other - Org Name:ANAHEIM CREST NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PATIENT ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-367-9546
Mailing Address - Street 1:3067 W ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3156
Mailing Address - Country:US
Mailing Address - Phone:714-827-2440
Mailing Address - Fax:714-827-2043
Practice Address - Street 1:3067 W ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3156
Practice Address - Country:US
Practice Address - Phone:714-827-2440
Practice Address - Fax:714-827-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55445HMedicaid
CALTC55445HMedicaid