Healthcare Provider Details

I. General information

NPI: 1780683326
Provider Name (Legal Business Name): BRIGHTON PLACE SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 EUCLID AVE
SAN DIEGO CA
92105-5424
US

IV. Provider business mailing address

1350 EUCLID AVE
SAN DIEGO CA
92105-5424
US

V. Phone/Fax

Practice location:
  • Phone: 619-263-2166
  • Fax: 619-263-5413
Mailing address:
  • Phone: 619-263-2166
  • Fax: 619-263-5413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. CAROL ANN VAN HORST
Title or Position: CFO
Credential: RN, NHA
Phone: 619-237-5555