| NPI | 1245604214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANAY LYNN FRY Owner 949-702-6306 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: CA 587) |
| Additional Taxonomies | 251E00000X Home Health (Licence: CA 587) |
| 310400000X Assisted Living Facility (Licence: CA 587) | |
| 313M00000X Nursing Facility/Intermediate Care Facility (Licence: CA 587) | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: CA 587) | |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2015-11-13 |