=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598871808
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOMERSET SPECIAL CARE CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2006
-----------------------------------------------------
Last Update Date | 02/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 151 CLAYDELLE AVE
-----------------------------------------------------
City | EL CAJON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92020-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-442-0245
-----------------------------------------------------
Fax | 619-442-3631
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 151 CLAYDELLE AVE
-----------------------------------------------------
City | EL CAJON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92020-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-442-0245
-----------------------------------------------------
Fax | 619-442-3631
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF LEGAL COUNSEL
-----------------------------------------------------
Name | MS. MARY PATRICIA MILLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-441-8771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 090000027
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------