Provider Demographics
NPI:1801643838
Name:AZALEA MANOR
Entity type:Organization
Organization Name:AZALEA MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDERSON
Authorized Official - Middle Name:BANGIS
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-687-3830
Mailing Address - Street 1:1559 ROYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-4223
Mailing Address - Country:US
Mailing Address - Phone:818-687-3830
Mailing Address - Fax:661-949-1034
Practice Address - Street 1:1759 WINDERMERE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5319
Practice Address - Country:US
Practice Address - Phone:818-687-3830
Practice Address - Fax:661-949-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility