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General NPI Number Information
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NPI Number | 1700927373
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Entity Type | Organization
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Legal Business Name | MARCEE LYNN HIRST
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 11966 TILDEN PL
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City | RIVERSIDE
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State | CA
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Zip | 92505-3143
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Country | US
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Telephone | 951-789-9698
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8175
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City | RIVERSIDE
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State | CA
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Zip | 92515-8175
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Country | US
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Telephone | 951-789-9698
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GREG HIRST
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Credential |
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Telephone | 951-789-9698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 250000758
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License Number State | CA
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