Provider Demographics
NPI:1952813016
Name:KINCAID SENIOR LIVING INC.
Entity Type:Organization
Organization Name:KINCAID SENIOR LIVING INC.
Other - Org Name:ANAHEIM CROWN PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:N
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-914-7226
Mailing Address - Street 1:PO BOX 74452
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-0149
Mailing Address - Country:US
Mailing Address - Phone:714-822-8878
Mailing Address - Fax:714-827-9637
Practice Address - Street 1:641 S BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3102
Practice Address - Country:US
Practice Address - Phone:714-827-7007
Practice Address - Fax:714-827-9637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306005316310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility