Provider Demographics
NPI:1679794309
Name:FOOTHILL CARE CENTER II, LLC
Entity type:Organization
Organization Name:FOOTHILL CARE CENTER II, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:DE ASIS
Authorized Official - Last Name:SALCEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-962-3274
Mailing Address - Street 1:1758 BIG DALTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-5910
Mailing Address - Country:US
Mailing Address - Phone:626-962-3274
Mailing Address - Fax:626-962-4424
Practice Address - Street 1:1304 W DURNESS ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-4766
Practice Address - Country:US
Practice Address - Phone:626-960-7273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60760FMedicaid