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General NPI Number Information
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NPI Number | 1477922425
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Entity Type | Organization
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Legal Business Name | CANYON HILL SENIOR HOME II
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 11075 POLARIS DR
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City | SAN DIEGO
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State | CA
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Zip | 92126-4703
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Country | US
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Telephone | 858-693-4393
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Fax | 858-693-6920
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Provider Business Mailing Address
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Address Line | 11075 POLARIS DR
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City | SAN DIEGO
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State | CA
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Zip | 92126-4703
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Country | US
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Telephone | 858-693-4393
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Fax | 858-693-6920
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. EDNA S ALBERTO
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Credential |
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Telephone | 858-774-3375
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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 | 374602316
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License Number State | CA
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