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General NPI Number Information
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NPI Number | 1023048295
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Entity Type | Organization
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Legal Business Name | JEFFREY PINE HOLDINGS, LLC
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 622 S ANZA ST
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City | EL CAJON
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State | CA
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Zip | 92020-6602
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Country | US
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Telephone | 619-442-0544
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Fax | 619-442-6177
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Provider Business Mailing Address
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Address Line | 262 N UNIVERSITY AVE
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City | FARMINGTON
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State | UT
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Zip | 84025-2975
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | MR. JOHN MITCHELL
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Credential |
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Telephone | 385-988-3319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 090000026
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License Number State | CA
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