MEDICARE: MORNINGSIDE MANOR LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1225764707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORNINGSIDE MANOR LLC

Provider Business Mailing Address
First Line	:	2847 MORNINGSIDE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92139-3527
Country	:	US
Telephone Number	:	619-856-4968
Fax Number	:

Provider Business Practice Location Address
First Line	:	2847 MORNINGSIDE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92139-3527
Country	:	US
Telephone Number	:	619-856-4968
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSEPH LI
Credential	:
Telephone Number	:	619-856-4968

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	07/27/2022

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Directions to “MORNINGSIDE MANOR LLC ” Practice Location

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