Provider Demographics
NPI:1942952866
Name:BANTAY RESIDENTIAL CARE INC.
Entity Type:Organization
Organization Name:BANTAY RESIDENTIAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIORENA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-262-1508
Mailing Address - Street 1:10541 DEBRA AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6741
Mailing Address - Country:US
Mailing Address - Phone:818-262-1508
Mailing Address - Fax:
Practice Address - Street 1:10541 DEBRA AVE
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6741
Practice Address - Country:US
Practice Address - Phone:818-262-1508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BANTAY RESIDENTIAL CARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility