Provider Demographics
NPI:1063987253
Name:OPTION ONE CONGREGATE LIVING FACILITY SANTA CLARITA INC
Entity type:Organization
Organization Name:OPTION ONE CONGREGATE LIVING FACILITY SANTA CLARITA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-977-1989
Mailing Address - Street 1:20251 LAKEMORE DR
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-1058
Mailing Address - Country:US
Mailing Address - Phone:661-977-1989
Mailing Address - Fax:661-977-1527
Practice Address - Street 1:20251 LAKEMORE DR
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-1058
Practice Address - Country:US
Practice Address - Phone:661-977-1989
Practice Address - Fax:661-977-1527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility