12072 Trask, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

38640058 Issued in CA

Legal business name

12072 TRASK, INC.

Practice address

12072 Trask Ave
Garden Grove, CA 92843-3821

Phone

(714) 534-1942

Fax

(714) 534-0967

NPI assigned

Jun 25, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Mark Uranga

Title

Assistant Administrator

Phone

(714) 534-1943

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205452800000",
    "number": "1811923303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12072 TRASK AVE",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928433821",
            "telephone_number": "714-534-1942",
            "fax_number": "714-534-0967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12072 TRASK AVE",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928433821",
            "telephone_number": "714-534-1942",
            "fax_number": "714-534-0967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "12072 TRASK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2008-03-14",
        "status": "A",
        "authorized_official_last_name": "URANGA",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "ASSISTANT ADMINISTRATOR",
        "authorized_official_telephone_number": "714-534-1943",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "38640058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05575H",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "38640058",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC70174F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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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 14, 2008; 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.