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General NPI Number Information
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NPI Number | 1760660336
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Entity Type | Organization
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Legal Business Name | MONARCH HOME
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 411 DENNIS DR
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City | VISTA
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State | CA
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Zip | 92083-7776
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Country | US
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Telephone | 760-842-5147
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Fax | 760-842-5148
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Provider Business Mailing Address
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Address Line | 411 DENNIS DR
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City | VISTA
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State | CA
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Zip | 92083-7776
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Country | US
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Telephone | 760-842-5147
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Fax | 760-842-5148
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Authorized Official
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Title or Position | OWNER
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Name | HERMINIO FERNANDEZ DELEON
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Credential |
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Telephone | 760-842-5147
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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 | LTC80409F
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License Number State | CA
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