Healthcare Provider Details

I. General information

NPI: 1447247333
Provider Name (Legal Business Name): BRIGHTON PLACE EAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 LAMAR ST
SPRING VALLEY CA
91977-2518
US

IV. Provider business mailing address

8625 LAMAR ST
SPRING VALLEY CA
91977-2518
US

V. Phone/Fax

Practice location:
  • Phone: 619-461-3222
  • Fax: 619-461-3575
Mailing address:
  • Phone: 619-461-3222
  • Fax: 619-461-3575

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: CAROLYN OLINGER
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 619-461-3222