Provider Demographics
NPI:1356480545
Name:JILL LEE
Entity Type:Organization
Organization Name:JILL LEE
Other - Org Name:JILL LEE DOING BUSINESS AS LAUREL HEIGHTS CONVALESCENT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING HOME ADM
Authorized Official - Phone:415-567-3133
Mailing Address - Street 1:2740 CALIFORNIA ST
Mailing Address - Street 2:NONE
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2514
Mailing Address - Country:US
Mailing Address - Phone:415-567-3133
Mailing Address - Fax:415-567-0250
Practice Address - Street 1:2740 CALIFORNIA ST
Practice Address - Street 2:NONE
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2514
Practice Address - Country:US
Practice Address - Phone:415-567-3133
Practice Address - Fax:415-567-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000109314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility