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General NPI Number Information
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NPI Number | 1689971954
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Entity Type | Organization
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Legal Business Name | WILDOMAR SENIOR PARTNERS II L.P.
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Dates
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Enumeration Date | 02/22/2011
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Last Update Date | 02/22/2011
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Provider Practice Location Address
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Address Line | 32365 S PASADENA ASSISTED LIVING
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City | WILDOMAR
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State | CA
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Zip | 92595-9551
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Country | US
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Telephone | 951-678-1555
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Fax | 951-678-1249
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Provider Business Mailing Address
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Address Line | PO BOX 740
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City | WILDOMAR
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State | CA
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Zip | 92595-0740
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Country | US
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Telephone | 951-678-1555
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Fax | 951-678-1249
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Authorized Official
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Title or Position | CEO
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Name | MR. WILLIAM CRAIG THRALLS
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Credential |
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Telephone | 951-678-1555
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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 | 336407346
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License Number State | CA
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