=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891414496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MISSION OF LOVE II INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2022
-----------------------------------------------------
Last Update Date | 08/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11991 7TH AVE
-----------------------------------------------------
City | HESPERIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92345-1742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-947-5211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7518 EL MANOR RD
-----------------------------------------------------
City | OAK HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92344-7818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-268-4548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JESSICA VILLANUEVA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-267-4548
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------