Provider Demographics
NPI:1578656427
Name:WINDSOR GARDENS HEALTHCARE CENTER OF FULLERTON, LLC
Entity Type:Organization
Organization Name:WINDSOR GARDENS HEALTHCARE CENTER OF FULLERTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ASH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAWLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-385-1090
Mailing Address - Street 1:9200 WEST SUNSET BLVD
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3603
Mailing Address - Country:US
Mailing Address - Phone:310-385-1090
Mailing Address - Fax:310-595-3792
Practice Address - Street 1:245 E WILSHIRE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1935
Practice Address - Country:US
Practice Address - Phone:714-871-6020
Practice Address - Fax:714-871-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000184314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05689GMedicaid
CA055689Medicare ID - Type Unspecified