# LAKE BALBOA HEALTH CARE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LAKE BALBOA POST-ACUTE REHAB
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053396366
- **Authorized official:** MARC JOHNSON (CFO)
- **Authorized official phone:** (949) 373-8373

## Contact information

- **Practice address:** 16955 VANOWEN ST, VAN NUYS, CA 91406-4542
- **Practice address phone:** (818) 343-0700
- **Mailing address:** 25910 ACERO STE 350, MISSION VIEJO, CA 92691-7908
- **Mailing address phone:** (949) 441-9258

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 920000005 | CA | Yes |

## Other

- **Enumeration date:** 12/08/2005
- **Last updated:** 04/05/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT06180I | — | CA |