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General NPI Number Information
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NPI Number | 1114247285
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Entity Type | Organization
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Legal Business Name | GARLYNCO INC. DBA OUR COUNTRYSIDE RESORT
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 18111 HAINES ST
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City | PERRIS
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State | CA
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Zip | 92570-9251
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Country | US
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Telephone | 951-657-3557
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Fax | 951-657-3773
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Provider Business Mailing Address
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Address Line | 18111 HAINES ST
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City | PERRIS
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State | CA
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Zip | 92570-9251
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Country | US
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Telephone | 951-657-3557
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Fax | 951-657-3773
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | MRS. LYNDA L. COMLEY
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Credential |
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Telephone | 951-657-3557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 336406991
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License Number State | CA
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