Healthcare Provider Details

I. General information

NPI: 1275351363
Provider Name (Legal Business Name): ESCONDIDO SH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2024
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 LAS VILLAS WAY
ESCONDIDO CA
92026-1946
US

IV. Provider business mailing address

1325 LAS VILLAS WAY
ESCONDIDO CA
92026-1946
US

V. Phone/Fax

Practice location:
  • Phone: 760-741-1047
  • Fax:
Mailing address:
  • Phone: 760-741-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MATHEW DINAPOLI
Title or Position: LICENSEE
Credential:
Phone: 310-612-5785