Provider Demographics
NPI:1265955298
Name:DESTINY LA PALMA ROYALE RETIREMENT INC.
Entity type:Organization
Organization Name:DESTINY LA PALMA ROYALE RETIREMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WATANABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-707-3212
Mailing Address - Street 1:1071 N BATAVIA ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5570
Mailing Address - Country:US
Mailing Address - Phone:714-707-3212
Mailing Address - Fax:
Practice Address - Street 1:525 W LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2432
Practice Address - Country:US
Practice Address - Phone:714-991-3242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306004691310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility