Provider Demographics
NPI:1871023374
Name:GENTLE MANOR ELDERLY CARE, INC.
Entity Type:Organization
Organization Name:GENTLE MANOR ELDERLY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAJUCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-335-2431
Mailing Address - Street 1:12733 ALCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7271
Mailing Address - Country:US
Mailing Address - Phone:562-335-2431
Mailing Address - Fax:
Practice Address - Street 1:4193 TERESA AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4238
Practice Address - Country:US
Practice Address - Phone:714-826-6144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306002859310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility