Organization
CANYON HOME III
Active
Other names
Canyon Homes Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD W. DENOGEAN RN (CEO)
(818) 353-8214
Entity
Organization
Contact information
Practice address
10712 ARTRUDE ST, SHADOW HILLS, CA 91040-1314
(818) 353-1514
Mailing address
10712 ARTRUDE ST, SHADOW HILLS, CA 91040-1314
(818) 353-8214
(818) 273-4479
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
960001061
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC60886F
—
CA
Enumeration date
01/24/2007
Last updated
04/08/2024
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