Provider Demographics
NPI:1932518909
Name:BROOKHURST RESIDENTIAL, INC.
Entity Type:Organization
Organization Name:BROOKHURST RESIDENTIAL, INC.
Other - Org Name:SEASIDE TERRACE RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KAROLINA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:FIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-962-5531
Mailing Address - Street 1:9925 LA ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3548
Mailing Address - Country:US
Mailing Address - Phone:714-962-5531
Mailing Address - Fax:818-638-5769
Practice Address - Street 1:9925 LA ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3548
Practice Address - Country:US
Practice Address - Phone:714-962-5531
Practice Address - Fax:818-638-5769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306004415310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility