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General NPI Number Information
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NPI Number | 1811468564
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Entity Type | Organization
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Legal Business Name | 3395493
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 4458 VIA DEL VALLE
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City | YORBA LINDA
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State | CA
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Zip | 92886-3021
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Country | US
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Telephone | 714-900-0694
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Fax | 714-463-4403
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Provider Business Mailing Address
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Address Line | 18340 YORBA LINDA BLVD # 443
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City | YORBA LINDA
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State | CA
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Zip | 92886-4058
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Country | US
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Telephone | 714-900-0694
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Fax | 714-463-4403
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DORSEY ROSE MARCHELLO
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Credential |
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Telephone | 714-900-0694
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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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