Healthcare Provider Details

I. General information

NPI: 1902851488
Provider Name (Legal Business Name): AUREUS ACQUISITION I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 S SAN DIMAS AVE
SAN DIMAS CA
91773-5108
US

IV. Provider business mailing address

790 WESTPARK DR. T-900, ATT: MEDICARE BILLING, M. GARCIA
MCLEAN VA
22102
US

V. Phone/Fax

Practice location:
  • Phone: 909-394-0304
  • Fax: 909-394-0903
Mailing address:
  • Phone: 703-854-0823
  • Fax: 703-854-0164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number197803192
License Number StateCA

VIII. Authorized Official

Name: JOHN M SPANN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 909-394-0304