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General NPI Number Information
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NPI Number | 1376901447
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Entity Type | Organization
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Legal Business Name | BRASWELL'S MEDITERRANEAN GARDENS, LP
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 12295 4TH ST
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City | YUCAIPA
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State | CA
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Zip | 92399-4120
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Country | US
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Telephone | 909-797-1131
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Fax | 909-797-9821
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Provider Business Mailing Address
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Address Line | 12295 FOURTH ST
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City | YUCAIPA
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State | CA
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Zip | 92399
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Country | US
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Telephone | 909-797-1131
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Fax | 909-797-2851
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JANET PICCINATI
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Credential |
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Telephone | 909-797-1131
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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 | 360900521
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License Number State | CA
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