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CANYON HOME III

Intermediate Care Mental Illness

Shadow Hills, California

Provider NPI: 1669527941

Organization Information:
Organization Name:  CANYON HOME III
Organization is not Subpart
Authorized Official:  RICHARD W. DENOGEAN  CEO  818-3531514

Practice Location:
10712 ARTRUDE ST  SHADOW HILLS, CA 91040 US
Tel: 818-353-1514  Fax: --

Business Mailing Address:
10712 ARTRUDE ST  SHADOW HILLS, CA 91040 US
Tel: 818-353-1514  Fax: --

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y310500000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mental Illness
CA

Other Provider Identifiers:

IssuerNumberStateType
LTC60886FCA05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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