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General NPI Number Information
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NPI Number | 1477933554
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Entity Type | Organization
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Legal Business Name | MULBERRY PLACE ASSISTED LIVING III
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 813 MULBERRY ST
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City | TEHACHAPI
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State | CA
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Zip | 93561-2253
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Country | US
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Telephone | 661-822-8077
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Fax | 661-822-4727
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Provider Business Mailing Address
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Address Line | 813 MULBERRY ST
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City | TEHACHAPI
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State | CA
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Zip | 93561-2253
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Country | US
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Telephone | 661-822-8077
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Fax | 661-822-4727
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Authorized Official
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Title or Position | CEO
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Name | MS. TIFFINI R HUGHES
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Credential |
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Telephone | 661-822-8077
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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 | 157206326
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License Number State | CA
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