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Organization
BROADWATER CASITAS CARE CENTER, LLC
Active
Organization
BROADWATER CASITAS CARE CENTER, LLC
Active
Other names
Casitas Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS EASTON (MANAGER)
(818) 368-1862
Entity
Organization
Contact information
Practice address
10626 BALBOA BLVD, GRANADA HILLS, CA 91344-6329
(818) 368-2802
(818) 368-0525
Mailing address
10626 BALBOA BLVD, GRANADA HILLS, CA 91344-6329
(818) 368-1862
(818) 368-8079
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
920000069
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548303472
—
CA
Enumeration date
02/14/2007
Last updated
06/09/2008
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