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General NPI Number Information
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NPI Number | 1134017650
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Entity Type | Organization
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Legal Business Name | THE SOUTH LANE II
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 12908 SOUTH LN
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City | REDLANDS
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State | CA
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Zip | 92373-7446
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Country | US
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Telephone | 909-351-6058
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Fax |
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Provider Business Mailing Address
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Address Line | 22800 SAVI RANCH PKWY STE 200
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City | YORBA LINDA
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State | CA
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Zip | 92887-4623
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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 | CEO/CO-FOUNDER
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Name | MR. ALLEN MEDINA
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Credential |
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Telephone | 714-450-2882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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