Provider Demographics
NPI:1679657878
Name:CALIFORNIA FRIENDS HOMES
Entity Type:Organization
Organization Name:CALIFORNIA FRIENDS HOMES
Other - Org Name:NEW LEAF REHAB AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-530-9100
Mailing Address - Street 1:12151 DALE STREET
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-3889
Mailing Address - Country:US
Mailing Address - Phone:714-530-9100
Mailing Address - Fax:714-530-0945
Practice Address - Street 1:12151 DALE STREET
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3889
Practice Address - Country:US
Practice Address - Phone:714-530-9100
Practice Address - Fax:714-530-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA056899261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056899Medicare Oscar/Certification