Provider Demographics
NPI:1588206700
Name:SISTINE MANOR INC
Entity Type:Organization
Organization Name:SISTINE MANOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LIN-LIN
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-337-7288
Mailing Address - Street 1:12755 TORCH ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706
Mailing Address - Country:US
Mailing Address - Phone:626-337-7288
Mailing Address - Fax:626-337-7289
Practice Address - Street 1:12755 TORCH ST
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706
Practice Address - Country:US
Practice Address - Phone:626-337-7288
Practice Address - Fax:626-337-7289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility