Basic Information
| Provider Information | |||||||||
| NPI: | 1578656427 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WINDSOR GARDENS HEALTHCARE CENTER OF FULLERTON, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9200 WEST SUNSET BLVD | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | WEST HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900693603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103851090 | ||||||||
| FaxNumber: | 3105953792 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 E WILSHIRE AVE | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928321935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148716020 | ||||||||
| FaxNumber: | 7148711321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 04/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | CHAWLA | ||||||||
| AuthorizedOfficialFirstName: | ASH | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3103851090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 060000184 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | ZZT05689G | 05 | CA | MEDICAID |