Star Icf/DD-N Wakefield Home

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

550000699 Issued in CA

Legal business name

STAR ICF/DD-N WAKEFIELD HOME

Practice address

14621 Wakefield St
Westminster, CA 92683-5718

Phone

(562) 400-1503

Fax

(174) 183-9863

NPI assigned

May 22, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Liza Daradar De Los Angeles, RN

Title

Owner/Administrator

Phone

(562) 400-1503

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211414400000",
    "number": "1821255258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14621 WAKEFIELD ST",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926835718",
            "telephone_number": "562-400-1503",
            "fax_number": "174-183-9863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14621 WAKEFIELD ST",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926835718",
            "telephone_number": "562-400-1503",
            "fax_number": "174-183-9863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAR ICF/DD-N WAKEFIELD HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-22",
        "last_updated": "2008-05-22",
        "status": "A",
        "authorized_official_last_name": "DE LOS ANGELES",
        "authorized_official_first_name": "LIZA",
        "authorized_official_middle_name": "DARADAR",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "562-400-1503",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "CA",
            "license": "550000699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nursing Facility/Intermediate Care Facility in Westminster, CA
• Providers in Westminster, CA by specialty
• Nursing Facility/Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 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.