13075 Blackbird Street Opco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

13075 BLACKBIRD STREET OPCO, LLC

Doing business as

Alta Gardens Care Center

Practice address

13075 Blackbird St
Garden Grove, CA 92843-2902

Phone

(714) 530-6322

NPI assigned

Mar 4, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Avrohom Tress

Title

Manager of Bold Quail 3 Operations

Phone

(310) 730-4800

Specialties & licenses 1

Addresses

Other names 1

• Alta Gardens Care Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1497512693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9526 W PICO BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900351202",
            "telephone_number": "310-730-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13075 BLACKBIRD ST",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928432902",
            "telephone_number": "714-530-6322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "13075 BLACKBIRD STREET OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-04",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "TRESS",
        "authorized_official_first_name": "AVROHOM",
        "authorized_official_title_or_position": "MANAGER OF BOLD QUAIL 3 OPERATIONS",
        "authorized_official_telephone_number": "310-730-4800"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alta Gardens Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.