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Organization

CANYON PROPERTIES III, LLC

Active
Other names
Country Manor Healthcare
Organization subpart
No

Provider details

NPI number
Authorized official
MARCIA S WELDON (ADMINISTRATOR)
(818) 899-0251
Entity
Organization

Contact information

Practice address
11723 FENTON AVE, LAKE VIEW TERRACE, CA 91342-6431
(818) 899-0251
(818) 890-5400
Mailing address
11723 FENTON AVE, LAKE VIEW TERRACE, CA 91342-6431
(818) 899-0251
(818) 890-5400

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
920000026
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
ZZT05002G
CA
Enumeration date
11/09/2005
Last updated
11/25/2014
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