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General NPI Number Information
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NPI Number | 1346798105
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Entity Type | Organization
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Legal Business Name | THE MONTEREY TRELLIS
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 8914 TROY ST
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City | SPRING VALLEY
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State | CA
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Zip | 91977-2609
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Country | US
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Telephone | 619-697-4656
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Fax |
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Provider Business Mailing Address
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Address Line | 8914 TROY ST.
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City | SPRING VALLEY
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State | CA
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Zip | 91977
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Country | US
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Telephone | 619-697-4656
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RODNEY P MICHEL
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Credential |
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Telephone | 619-846-0730
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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 | 374601400
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License Number State | CA
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