=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063657849
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDAREMOS TERRACE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2008
-----------------------------------------------------
Last Update Date | 12/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 VIA ANDAREMOS
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92673-7034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-545-6867
-----------------------------------------------------
Fax | 949-606-9101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 VIA ANDAREMOS
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92673-7034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-545-6867
-----------------------------------------------------
Fax | 949-606-9101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. LIZA A AUGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-454-6867
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------