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General NPI Number Information
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NPI Number | 1750160719
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Entity Type | Organization
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Legal Business Name | SHINING BRIGHT SENIOR CARE HOME INC.
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 697 PLUMER ST
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City | COSTA MESA
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State | CA
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Zip | 92627-2720
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Country | US
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Telephone | 714-749-6629
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Fax | 657-223-6796
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Provider Business Mailing Address
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Address Line | 7429 E CALICO TRL
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City | ORANGE
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State | CA
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Zip | 92869-2415
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Country | US
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Telephone | 714-749-6629
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Fax | 657-223-6796
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. KATHRINA PADOR BULLER
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Credential |
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Telephone | 714-749-6629
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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 |
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License Number State |
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