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General NPI Number Information
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NPI Number | 1902179609
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Entity Type | Organization
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Legal Business Name | MCGUIRES GUEST HOME INC.
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Dates
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Enumeration Date | 02/12/2012
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Last Update Date | 02/12/2012
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Provider Practice Location Address
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Address Line | 3442 CALIFORNIA AVE
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City | CARMICHAEL
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State | CA
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Zip | 95608-3474
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Country | US
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Telephone | 916-944-7447
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Fax | 916-944-3124
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Provider Business Mailing Address
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Address Line | 3442 CALIFORNIA AVE
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City | CARMICHAEL
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State | CA
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Zip | 95608-3474
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Country | US
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Telephone | 916-944-7447
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Fax | 916-944-3124
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | MRS. THERESA LEA MCKAY
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Credential | ADMIT CERT
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Telephone | 916-944-7447
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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 | 347003336
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License Number State | CA
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