Provider Demographics
NPI:1598338725
Name:HAWTHORNE TERRACE CARE HOME
Entity Type:Organization
Organization Name:HAWTHORNE TERRACE CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCFE ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-508-8984
Mailing Address - Street 1:4760 W 123RD ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3606
Mailing Address - Country:US
Mailing Address - Phone:707-508-8984
Mailing Address - Fax:707-708-2908
Practice Address - Street 1:4760 W 123RD ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3606
Practice Address - Country:US
Practice Address - Phone:707-508-8984
Practice Address - Fax:707-708-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-24
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility