Organization
THE PROVIDENCE MANOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ANN NALANGAN DE LIMA (MANAGING MEMBER)
(323) 680-0844
Entity
Organization
Contact information
Practice address
3434 TAMARISK DR, PALMDALE, CA 93551-2561
(323) 680-0844
Mailing address
3434 TAMARISK DR, PALMDALE, CA 93551-2561
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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