MEDICARE: MONZE SENIOR RESIDENTIAL CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1033644570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONZE SENIOR RESIDENTIAL CARE INC

Provider Business Mailing Address
First Line	:	1143 PURDY ST
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-4754
Country	:	US
Telephone Number	:	619-464-1936
Fax Number	:	619-286-0757

Provider Business Practice Location Address
First Line	:	1143 PURDY ST
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-4754
Country	:	US
Telephone Number	:	619-464-1936
Fax Number	:	619-286-0757

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAGALY NOEMI FLORES
Credential	:
Telephone Number	:	619-464-1936

Provider Enumeration Date	:	04/21/2017
Last Update Date	:	04/21/2017

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