Provider Demographics
NPI:1962592683
Name:CALIFORNIA FRIENDS HOME
Entity type:Organization
Organization Name:CALIFORNIA FRIENDS HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICARE BILLER
Authorized Official - Prefix:MISS
Authorized Official - First Name:YOLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VIERNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-971-6605
Mailing Address - Street 1:12151 DALE STREET
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-3889
Mailing Address - Country:US
Mailing Address - Phone:714-530-9100
Mailing Address - Fax:714-530-0945
Practice Address - Street 1:12151 DALE STREET
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3889
Practice Address - Country:US
Practice Address - Phone:714-530-9100
Practice Address - Fax:714-530-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1211180001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1211180001Medicare NSC