=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962293464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPENCER'S CROSSING SENIOR ASSISTED LIVING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2025
-----------------------------------------------------
Last Update Date | 05/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35681 SILVERWEED RD
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-7985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-600-0570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35681 SILVERWEED RD
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-7985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-600-0570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSEE
-----------------------------------------------------
Name | MARIBEL BARROSO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 951-600-9930
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------