Provider Demographics
NPI:1639178197
Name:ALDERWOOD INC
Entity Type:Organization
Organization Name:ALDERWOOD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:626-282-8431
Mailing Address - Street 1:115 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2719
Mailing Address - Country:US
Mailing Address - Phone:626-289-4439
Mailing Address - Fax:626-289-0056
Practice Address - Street 1:115 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-2719
Practice Address - Country:US
Practice Address - Phone:626-289-4439
Practice Address - Fax:626-289-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950000007314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA055441Medicaid
CA055441Medicare Oscar/Certification