Healthcare Provider Details

I. General information

NPI: 1477933554
Provider Name (Legal Business Name): MULBERRY PLACE ASSISTED LIVING III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 MULBERRY ST
TEHACHAPI CA
93561-2253
US

IV. Provider business mailing address

813 MULBERRY ST
TEHACHAPI CA
93561-2253
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-8077
  • Fax: 661-822-4727
Mailing address:
  • Phone: 661-822-8077
  • Fax: 661-822-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number157206326
License Number StateCA

VIII. Authorized Official

Name: MS. TIFFINI R HUGHES
Title or Position: CEO
Credential:
Phone: 661-822-8077