Healthcare Provider Details

I. General information

NPI: 1912915760
Provider Name (Legal Business Name): BRIGHTON PLACE OF LA MESA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7760 PARKWAY DR
LA MESA CA
91942-2028
US

IV. Provider business mailing address

7760 PARKWAY DR
LA MESA CA
91942-2028
US

V. Phone/Fax

Practice location:
  • Phone: 619-469-0124
  • Fax: 619-469-6401
Mailing address:
  • Phone: 619-469-0124
  • Fax: 619-469-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number080000053
License Number StateCA

VIII. Authorized Official

Name: AARON CHESLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 619-469-0124