Provider Demographics
NPI:1568677342
Name:CORINTHIAN SUB ACUTE & REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:CORINTHIAN SUB ACUTE & REHABILITATION CENTER INC
Other - Org Name:CORINTHIAN GARDENS HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-348-8422
Mailing Address - Street 1:10429 AMBERWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326
Mailing Address - Country:US
Mailing Address - Phone:818-348-8422
Mailing Address - Fax:818-348-1940
Practice Address - Street 1:1611 HEIGHT ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-2840
Practice Address - Country:US
Practice Address - Phone:661-872-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-04-15
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
CA1568677342Medicaid
CA555847Medicare Oscar/Certification