Provider Demographics
NPI:1023708906
Name:CROSS CREEK MANOR INC.
Entity type:Organization
Organization Name:CROSS CREEK MANOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-519-5878
Mailing Address - Street 1:138 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3035
Mailing Address - Country:US
Mailing Address - Phone:714-519-5878
Mailing Address - Fax:
Practice Address - Street 1:138 E 18TH ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3035
Practice Address - Country:US
Practice Address - Phone:714-519-5878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility