Provider Demographics
NPI:1114196631
Name:MIRAJOY RESIDENTIAL CARE FACILITIES INC
Entity Type:Organization
Organization Name:MIRAJOY RESIDENTIAL CARE FACILITIES INC
Other - Org Name:MIRAJOY HOME 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:CAMPOS
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-636-2478
Mailing Address - Street 1:25376 MAXIMUS ST
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4518
Mailing Address - Country:US
Mailing Address - Phone:949-636-2478
Mailing Address - Fax:949-587-9453
Practice Address - Street 1:23711 PROSPECT VALLEY DR
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1637
Practice Address - Country:US
Practice Address - Phone:909-860-2150
Practice Address - Fax:909-860-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities