Provider Demographics
NPI:1750068177
Name:LIFE CARE SENIOR MANOR LLC
Entity type:Organization
Organization Name:LIFE CARE SENIOR MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CELIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-573-6489
Mailing Address - Street 1:10415 AZALEA CIR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-2007
Mailing Address - Country:US
Mailing Address - Phone:949-573-6489
Mailing Address - Fax:
Practice Address - Street 1:10415 AZALEA CIR
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-2007
Practice Address - Country:US
Practice Address - Phone:949-573-6489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility