MEDICARE: NOVELLUS CLAIREMONT

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	:	1437917051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVELLUS CLAIREMONT

Provider Business Mailing Address
First Line	:	3001 LAVA RIDGE CT STE 340
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-2838
Country	:	US
Telephone Number	:	406-493-5568
Fax Number	:

Provider Business Practice Location Address
First Line	:	5219 CLAIREMONT MESA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2206
Country	:	US
Telephone Number	:	406-493-5568
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS SPECIALIST
Name	:	RHONDA B DOLCATER
Credential	:
Telephone Number	:	406-493-5568

Provider Enumeration Date	:	03/08/2024
Last Update Date	:	03/08/2024

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