Organization
ANTELOPE HILLS MANOR ICF DD-N INC.
Active
Parent organization
ANTELOPE HILLS MANOR ICF DD-N INC.
Other names
klamath home icf dd-n
Organization subpart
Yes
Provider details
NPI number
Legal business name
ANTELOPE HILLS MANOR ICF DD-N INC.
Authorized official
MR. ANTONIO GAGANTE RANIT RN (PRESIDENT)
(916) 721-9439
Entity
Organization
Contact information
Practice address
5355 KLAMATH DR, SACRAMENTO, CA 95842-2651
(916) 332-1439
(916) 332-4716
Mailing address
7704 ANTELOPE HILLS DR, ANTELOPE, CA 95843-2491
(916) 721-1517
(916) 721-0762
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
550000069
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC80373F
CALIFORNIA MEDI-CAL
CA
Enumeration date
05/02/2008
Last updated
05/02/2008
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