Organization
12072 TRASK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK URANGA (ASSISTANT ADMINISTRATOR)
(714) 534-1943
Entity
Organization
Contact information
Practice address
12072 TRASK AVE, GARDEN GROVE, CA 92843-3821
(714) 534-1942
(714) 534-0967
Mailing address
12072 TRASK AVE, GARDEN GROVE, CA 92843-3821
(714) 534-1942
(714) 534-0967
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
38640058
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38640058
STATE LICENSE NUMBER
CA
05
—
LTC70174F
—
CA
05
—
ZZT05575H
—
CA
Enumeration date
06/25/2006
Last updated
03/14/2008
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