Provider Demographics
NPI:1295154862
Name:ANTELOPE HILLS MANOR ICF/DD-N INC.
Entity type:Organization
Organization Name:ANTELOPE HILLS MANOR ICF/DD-N INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:G
Authorized Official - Last Name:RANIT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-548-1397
Mailing Address - Street 1:9500 LITTORAL ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9168
Mailing Address - Country:US
Mailing Address - Phone:916-548-1397
Mailing Address - Fax:916-721-9439
Practice Address - Street 1:8014 RIVERGREEN DR
Practice Address - Street 2:
Practice Address - City:ELVERTA
Practice Address - State:CA
Practice Address - Zip Code:95626-9653
Practice Address - Country:US
Practice Address - Phone:916-548-1397
Practice Address - Fax:916-721-9439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility