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General NPI Number Information
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NPI Number | 1437338217
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Entity Type | Organization
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Legal Business Name | INNOVATIVE LAKE FOREST OPERATIONS, LLC
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 23442 EL TORO RD
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City | LAKE FOREST
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State | CA
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Zip | 92630-6979
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Country | US
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Telephone | 800-584-8084
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Fax |
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Provider Business Mailing Address
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Address Line | 1282 PACIFIC OAKS PL
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City | ESCONDIDO
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State | CA
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Zip | 92029-2900
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Country | US
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Telephone | 760-690-5262
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | NICK DOBRON
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Credential |
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Telephone | 760-690-5262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | PENDING
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License Number State | CA
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