| NPI | 1417259490 |
|---|---|
| Doing Business As | WISTERIA PLACE |
| Entity Type | Organization |
| Authorized Contact | SOON BURNAM Treasurer 949-540-1249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2021-03-01 |