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1861260119
DIVINE LIGHT CARE HOME LLC
LA MESA, CA
NPI
1861260119
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Entity Type
Organization
Authorized Contact
ROGELIO DIAZ
Licensee
619-769-4545
Organization Subpart ?
No
Primary Taxonomy
310400000X Assisted Living Facility
Enumeration Date
2023-12-15
Last Update Date
2023-12-15
Business Address
DIVINE LIGHT CARE HOME LLC
5105 BANCROFT DR
LA MESA, CA 91941-4204
Phone number: 619-769-4545
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Mailing Address
DIVINE LIGHT CARE HOME LLC
5105 BANCROFT DR
LA MESA, CA 91941-4204
Phone number: 619-769-4545
Copy
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