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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