Provider Demographics
NPI:1194125658
Name:BALDWIN PARK CONGREGATE HOME INC
Entity type:Organization
Organization Name:BALDWIN PARK CONGREGATE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:ELEGIO
Authorized Official - Last Name:EDANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-908-0846
Mailing Address - Street 1:3462 VINELAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-5314
Mailing Address - Country:US
Mailing Address - Phone:626-960-6500
Mailing Address - Fax:626-960-4500
Practice Address - Street 1:3462 VINELAND AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5314
Practice Address - Country:US
Practice Address - Phone:626-960-6500
Practice Address - Fax:626-960-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002799311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home