Provider Demographics
NPI:1255526513
Name:LIFEHOUSE MACLAY OPERATIONS, LLC
Entity type:Organization
Organization Name:LIFEHOUSE MACLAY OPERATIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRIOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:310-337-1929
Mailing Address - Street 1:329 NORTH REAL ROAD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1820
Mailing Address - Country:US
Mailing Address - Phone:661-327-7107
Mailing Address - Fax:661-327-1152
Practice Address - Street 1:12831 MACLAY ST
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4934
Practice Address - Country:US
Practice Address - Phone:818-361-4455
Practice Address - Fax:818-837-1180
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEHOUSE HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-10
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555583Medicare Oscar/Certification