Organization
CLUBHOUSE SENIOR ESTATE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY TADEO (CEO)
(909) 900-6064
Entity
Organization
Contact information
Practice address
1324 S FANN ST, ANAHEIM, CA 92804-5648
(909) 900-6064
Mailing address
1324 S FANN ST, ANAHEIM, CA 92804-5648
(909) 900-6064
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
04/27/2026
Last updated
04/27/2026
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