=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225430580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIGHT CHOICE SENIOR LIVING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2014
-----------------------------------------------------
Last Update Date | 09/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6354 CASCADE ST
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92122-2421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-246-2003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6354 CASCADE ST
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92122-2421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-246-2003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCIPAL MANAGER
-----------------------------------------------------
Name | TODD BROOK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-246-2003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 374603297
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------