=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700283348
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROLLING MEADOWS CARE HOMES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2014
-----------------------------------------------------
Last Update Date | 11/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1723 CASERO PL
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92029-4215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-294-3877
-----------------------------------------------------
Fax | 760-233-8917
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 90155
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92169-2155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-994-5048
-----------------------------------------------------
Fax | 760-233-8917
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSEE
-----------------------------------------------------
Name | MRS. MICHELLE G RETZER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-994-5048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 374603436
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------