Provider Demographics
NPI:1528049954
Name:ATHERTON BAPTIST HOMES
Entity type:Organization
Organization Name:ATHERTON BAPTIST HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NHA 3423
Authorized Official - Phone:626-289-4178
Mailing Address - Street 1:214 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3298
Mailing Address - Country:US
Mailing Address - Phone:626-289-4178
Mailing Address - Fax:626-576-0857
Practice Address - Street 1:214 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3298
Practice Address - Country:US
Practice Address - Phone:626-289-4178
Practice Address - Fax:626-576-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZT18524FMedicaid
CA555272Medicare ID - Type Unspecified