MEDICARE: POLINSKY CHILDREN'S CENTER

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	385H00000X	Respite Care

General Provider Information

NPI Number	:	1295854073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLINSKY CHILDREN'S CENTER

Provider Business Mailing Address
First Line	:	8365 BROADWAY APT 12
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-2038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8365 BROADWAY #12
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945
Country	:	US
Telephone Number	:	619-808-9342
Fax Number	:

Authorized Official
Title or Position	:	RESIDENTIAL CARE SUPERVISOR
Name	:	MRS. MYRNA MURILLO
Credential	:
Telephone Number	:	858-967-1428

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/14/2008

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