Provider Demographics
NPI:1417554726
Name:PINK CORAL RESIDENCE II
Entity Type:Organization
Organization Name:PINK CORAL RESIDENCE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-447-4802
Mailing Address - Street 1:40343 15TH ST W
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3128
Mailing Address - Country:US
Mailing Address - Phone:661-480-5985
Mailing Address - Fax:
Practice Address - Street 1:40343 15TH ST W
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3128
Practice Address - Country:US
Practice Address - Phone:661-480-5985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility