Provider Demographics
NPI:1124023403
Name:MAYFLOWER GARDENS HEALTH FACILITIES INC
Entity type:Organization
Organization Name:MAYFLOWER GARDENS HEALTH FACILITIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V.P. OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-257-5100
Mailing Address - Street 1:6705 COLUMBIA WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1233
Mailing Address - Country:US
Mailing Address - Phone:661-943-3212
Mailing Address - Fax:661-943-1303
Practice Address - Street 1:6705 COLUMBIA WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-1233
Practice Address - Country:US
Practice Address - Phone:661-943-3212
Practice Address - Fax:661-943-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA920000048314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06286GMedicaid
CA2592824Medicare UPIN
CAZZT06286GMedicaid