Provider Demographics
NPI:1821027632
Name:DOUGLAS FIR HOLDINGS, LLC
Entity Type:Organization
Organization Name:DOUGLAS FIR HOLDINGS, LLC
Other - Org Name:HUNTINGTON VALLEY HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-471-0388
Mailing Address - Street 1:8382 NEWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7038
Mailing Address - Country:US
Mailing Address - Phone:714-842-5551
Mailing Address - Fax:714-848-5359
Practice Address - Street 1:8382 NEWMAN AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7038
Practice Address - Country:US
Practice Address - Phone:714-842-5551
Practice Address - Fax:714-848-5359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000206314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821027632Medicaid
CALTC70171FMedicaid
CAZZT05888HMedicaid
CAZZT05888HMedicaid