Provider Demographics
NPI:1154778850
Name:THE HEATHERS SENIOR CARE, INC
Entity type:Organization
Organization Name:THE HEATHERS SENIOR CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMBRUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH/EF/RCFE ADMINIST
Authorized Official - Phone:949-631-5222
Mailing Address - Street 1:PO BOX 15926
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-5926
Mailing Address - Country:US
Mailing Address - Phone:949-631-5222
Mailing Address - Fax:949-631-0522
Practice Address - Street 1:1565 WINTERGREEN PL
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2524
Practice Address - Country:US
Practice Address - Phone:949-631-5222
Practice Address - Fax:949-631-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3060019813104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances