Healthcare Provider Details

I. General information

NPI: 1437520400
Provider Name (Legal Business Name): MEADOWBROOK VILLAGE CHRISTIAN RETIREMENT COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOLLAND GLN
ESCONDIDO CA
92026-1354
US

IV. Provider business mailing address

100 HOLLAND GLN
ESCONDIDO CA
92026-1354
US

V. Phone/Fax

Practice location:
  • Phone: 760-746-2500
  • Fax:
Mailing address:
  • Phone: 760-746-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MARK MEMMELAAR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 760-746-2500