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General NPI Number Information
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NPI Number | 1154695880
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Entity Type | Organization
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Legal Business Name | FOUNTAINS SEA BLUFFS, SL, LP
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Dates
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Enumeration Date | 02/27/2012
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 25411 SEA BLUFFS DR
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City | DANA POINT
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State | CA
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Zip | 92629-2190
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Country | US
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Telephone | 949-234-3001
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Fax | 949-489-8159
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Provider Business Mailing Address
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Address Line | 25411 SEA BLUFFS DR
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City | DANA POINT
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State | CA
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Zip | 92629-2190
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Country | US
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Telephone | 949-234-3001
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Fax | 949-489-8159
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TERRY J BROWN
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Credential |
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Telephone | 949-234-3001
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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 | 306004270
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License Number State | CA
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