Healthcare Provider Details

I. General information

NPI: 1982434791
Provider Name (Legal Business Name): SUMMERVILLE AT COBBCO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N LYON AVE
HEMET CA
92545-1753
US

IV. Provider business mailing address

1001 N LYON AVE
HEMET CA
92545-1753
US

V. Phone/Fax

Practice location:
  • Phone: 951-925-0822
  • Fax:
Mailing address:
  • Phone: 951-925-0822
  • 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: ANNA MUNOZ
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 414-918-5443