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General NPI Number Information
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NPI Number | 1891277471
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Entity Type | Organization
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Legal Business Name | ANGELIC MANSIONS, LLC
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 08/30/2018
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Provider Practice Location Address
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Address Line | 7585 WARREN VISTA AVE
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-3847
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Country | US
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Telephone | 760-365-4620
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Fax |
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Provider Business Mailing Address
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Address Line | 7585 WARREN VISTA AVE
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-3847
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SHEIBA RAJADAS
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Credential |
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Telephone | 310-259-6877
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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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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 361800118
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License Number State | CA
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