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General NPI Number Information
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NPI Number | 1861258485
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Entity Type | Organization
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Legal Business Name | PARKMOUNT MANOR LLC
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Dates
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Enumeration Date | 02/21/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 1001 YARDLEY WAY
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City | CORONA
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State | CA
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Zip | 92881-7434
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Country | US
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Telephone | 951-870-7189
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Fax |
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Provider Business Mailing Address
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Address Line | 4264 WINDSPRING CIR
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City | CORONA
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State | CA
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Zip | 92883-5925
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Country | US
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Telephone | 951-870-7189
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GEOFFREY BROUILLETTE
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Credential |
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Telephone | 951-870-7189
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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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