Provider Demographics
NPI:1649011214
Name:GOLDEN BREEZE MANOR LLC
Entity type:Organization
Organization Name:GOLDEN BREEZE MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:RAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELOS SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-227-6557
Mailing Address - Street 1:28891 CALLE JUCA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1417
Mailing Address - Country:US
Mailing Address - Phone:714-227-6557
Mailing Address - Fax:
Practice Address - Street 1:28891 CALLE JUCA
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1417
Practice Address - Country:US
Practice Address - Phone:714-227-6557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility