Healthcare Provider Details

I. General information

NPI: 1841127545
Provider Name (Legal Business Name): FOUR SULLIVAN ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 VALLECITOS DE ORO STE D
SAN MARCOS CA
92069-1461
US

IV. Provider business mailing address

135 VALLECITOS DE ORO STE D
SAN MARCOS CA
92069-1461
US

V. Phone/Fax

Practice location:
  • Phone: 760-736-9934
  • Fax: 760-736-3162
Mailing address:
  • Phone: 760-736-9934
  • Fax: 760-736-3162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JAIME MICHELLE DILL
Title or Position: PRESIDENT
Credential:
Phone: 760-736-9934