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General NPI Number Information
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NPI Number | 1679907992
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Entity Type | Organization
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Legal Business Name | QUEENS MANOR HOME CARE INC.
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Dates
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Enumeration Date | 08/22/2013
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 1025 BONNIE BRAE PL
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City | VISTA
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State | CA
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Zip | 92084-5529
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Country | US
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Telephone | 760-806-9455
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Fax | 760-806-9455
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Provider Business Mailing Address
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Address Line | 1025 BONNIE BRAE PLACE
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City | VISTA
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State | CA
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Zip | 92084
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Country | US
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Telephone | 760-216-8024
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Fax | 760-806-9455
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Authorized Official
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Title or Position | ADMINISTRATOR/LICENSEE
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Name | MRS. JANE TACAY TOTANES
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Credential | LVN
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Telephone | 760-716-9301
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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 | 374603285
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License Number State | CA
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