Provider Demographics
NPI:1447611298
Name:RAC BRITTANY HOUSE
Entity Type:Organization
Organization Name:RAC BRITTANY HOUSE
Other - Org Name:BRITTANY HOUSE-RESIDENTIAL ALZHEIMERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-565-4424
Mailing Address - Street 1:9619 CHESAPEAKE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1368
Mailing Address - Country:US
Mailing Address - Phone:858-565-4424
Mailing Address - Fax:858-565-1508
Practice Address - Street 1:5641 CENTRALIA AVENUE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808
Practice Address - Country:US
Practice Address - Phone:562-421-4717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191601027311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)