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General NPI Number Information
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NPI Number | 1407185127
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Entity Type | Organization
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Legal Business Name | SUMMERVILLE AT COBBCO, INC.
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Dates
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Enumeration Date | 12/08/2009
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 10200 CHAPMAN AVE
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City | GARDEN GROVE
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State | CA
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Zip | 92840-2858
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Country | US
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Telephone | 714-636-6453
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Fax | 714-636-0978
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Provider Business Mailing Address
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Address Line | 10200 CHAPMAN AVE
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City | GARDEN GROVE
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State | CA
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Zip | 92840-2858
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Country | US
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Telephone | 714-636-6453
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | JOANNE LESKOWICZ
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Credential |
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Telephone | 414-918-5000
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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 | 306000831
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License Number State | CA
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