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General NPI Number Information
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NPI Number | 1437365988
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Entity Type | Organization
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Legal Business Name | MONTICELLO GUEST HOME, INC.
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4951 E EIGHT MILE RD
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City | STOCKTON
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State | CA
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Zip | 95212-9449
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Country | US
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Telephone | 209-334-1151
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Fax | 209-367-1315
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Provider Business Mailing Address
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Address Line | PO BOX 690069
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City | STOCKTON
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State | CA
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Zip | 95269-0069
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Country | US
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Telephone | 209-727-5749
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Fax | 209-727-5749
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. REMEDIOS RESPICIO TABANGCURA
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Credential | RN
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Telephone | 209-298-0371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State | CA
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