Provider Demographics
NPI:1447069224
Name:MARCELA'S HOME
Entity type:Organization
Organization Name:MARCELA'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:415-713-9267
Mailing Address - Street 1:2120 S STATE COLLEGE BLVD APT 2041
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-6218
Mailing Address - Country:US
Mailing Address - Phone:415-713-9267
Mailing Address - Fax:
Practice Address - Street 1:1969 N. LILAC AVENUE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-2377
Practice Address - Country:US
Practice Address - Phone:415-713-9267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility