# ANTELOPE HILLS MANOR ICF DD-N INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ANTELOPE HILLS MANOR ICF DD-N INC.
- **Other names:** klamath home icf dd-n
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1205002904
- **Legal business name:** ANTELOPE HILLS MANOR ICF DD-N INC.
- **Authorized official:** MR. ANTONIO GAGANTE RANIT RN (PRESIDENT)
- **Authorized official phone:** (916) 721-9439

## Contact information

- **Practice address:** 5355 KLAMATH DR, SACRAMENTO, CA 95842-2651
- **Practice address phone:** (916) 332-1439
- **Practice address fax:** (916) 332-4716
- **Mailing address:** 7704 ANTELOPE HILLS DR, ANTELOPE, CA 95843-2491
- **Mailing address phone:** (916) 721-1517
- **Mailing address fax:** (916) 721-0762

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 550000069 | CA | Yes |

## Other

- **Enumeration date:** 05/02/2008
- **Last updated:** 05/02/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | LTC80373F | CALIFORNIA MEDI-CAL | CA |