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General NPI Number Information
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NPI Number | 1477795144
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Entity Type | Organization
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Legal Business Name | SP MARAVILLA LLC
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 5486 CALLE REAL
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City | SANTA BARBARA
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State | CA
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Zip | 93111-1645
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Country | US
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Telephone | 805-967-1965
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Fax |
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Provider Business Mailing Address
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Address Line | 5486 CALLE REAL
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City | SANTA BARBARA
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State | CA
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Zip | 93111-1645
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Country | US
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Telephone | 805-967-1965
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESID
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Name | MR. J WICKLIFFE PETERSON
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Credential |
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Telephone | 858-792-9300
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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 | 428501038
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License Number State | CA
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