Provider Demographics
NPI:1194579805
Name:FHJ MANOR LLC
Entity type:Organization
Organization Name:FHJ MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JETHRONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED VOCATIONAL
Authorized Official - Phone:661-563-1761
Mailing Address - Street 1:4430 DIAMOND ROCK CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-5497
Mailing Address - Country:US
Mailing Address - Phone:661-563-1761
Mailing Address - Fax:
Practice Address - Street 1:200 TRINITY AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-3628
Practice Address - Country:US
Practice Address - Phone:661-563-1761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FHJ MANOR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility