Healthcare Provider Details

I. General information

NPI: 1104363795
Provider Name (Legal Business Name): SENIOR COAST LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/31/2022
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 ELDEN STREET
LA MESA CA
91942-3211
US

IV. Provider business mailing address

8780 ELDEN STREET
LA MESA CA
91942-3211
US

V. Phone/Fax

Practice location:
  • Phone: 949-244-9405
  • Fax:
Mailing address:
  • Phone: 858-946-3100
  • Fax: 619-432-6723

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: MS. ELIANNA Z. REUBEN
Title or Position: CEO
Credential:
Phone: 949-244-9405