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General NPI Number Information
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NPI Number | 1104363795
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Entity Type | Organization
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Legal Business Name | SENIOR COAST LIVING, LLC
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 8780 ELDEN STREET
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City | LA MESA
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State | CA
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Zip | 91942-3211
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Country | US
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Telephone | 949-244-9405
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Fax |
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Provider Business Mailing Address
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Address Line | 8780 ELDEN STREET
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City | LA MESA
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State | CA
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Zip | 91942-3211
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Country | US
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Telephone | 858-946-3100
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Fax | 619-432-6723
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Authorized Official
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Title or Position | CEO
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Name | MS. ELIANNA Z. REUBEN
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Credential |
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Telephone | 949-244-9405
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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 |
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License Number State |
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