Provider Demographics
NPI:1568842649
Name:MULBERRY PLACE ASSISTED LIVING
Entity Type:Organization
Organization Name:MULBERRY PLACE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFINI
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-822-8077
Mailing Address - Street 1:809 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-2253
Mailing Address - Country:US
Mailing Address - Phone:661-822-8077
Mailing Address - Fax:661-822-4727
Practice Address - Street 1:809 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-2253
Practice Address - Country:US
Practice Address - Phone:661-822-8077
Practice Address - Fax:661-822-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157206279310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility