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General NPI Number Information
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NPI Number | 1811156524
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Entity Type | Organization
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Legal Business Name | JENYMEL'S HOME
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 18314 IBEX AVE
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City | ARTESIA
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State | CA
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Zip | 90701-5757
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Country | US
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Telephone | 562-924-8557
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Fax | 562-860-3048
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Provider Business Mailing Address
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Address Line | 2790 HIDDEN HILLS WAY
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City | CORONA
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State | CA
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Zip | 92882-8027
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Country | US
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Telephone | 714-875-0581
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Fax | 562-860-3048
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MRS. MARYANN B OPENA
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Credential | BSEE-HE
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Telephone | 714-875-0581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | CA
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