Organization
ANTELOPE HILLS MANOR ICF DDN INC
Active
Other names
klamath home icf ddn
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTONIO GAGANTE RANIT REGISTERED NURSE (RN ADMINISTRATOR QMRP)
(916) 721-9439
Entity
Organization
Contact information
Practice address
7704 ANTELOPE HILLS DR, ANTELOPE, CA 95843-2491
(916) 721-1517
(916) 721-0762
Mailing address
7704 ANTELOPE HILLS DR, ANTELOPE, CA 95843-2491
(916) 721-1517
(916) 721-0762
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC80334F
—
CA
05
—
LTC80373F
—
CA
Enumeration date
02/05/2007
Last updated
08/22/2020
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