Provider Demographics
NPI:1427733054
Name:SEDONA GUEST HOME
Entity type:Organization
Organization Name:SEDONA GUEST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / LICENSEE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBOLEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-421-0594
Mailing Address - Street 1:5325 LA CANADA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1724
Mailing Address - Country:US
Mailing Address - Phone:818-421-0594
Mailing Address - Fax:
Practice Address - Street 1:21635 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6220
Practice Address - Country:US
Practice Address - Phone:310-792-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility