Provider Demographics
NPI:1609180850
Name:A AND D AT CORTEZ LLC
Entity Type:Organization
Organization Name:A AND D AT CORTEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:POSA
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:760-325-4146
Mailing Address - Street 1:378 W CORTEZ RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-1910
Mailing Address - Country:US
Mailing Address - Phone:760-325-4146
Mailing Address - Fax:760-325-4114
Practice Address - Street 1:378 W CORTEZ RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-1910
Practice Address - Country:US
Practice Address - Phone:760-325-4146
Practice Address - Fax:760-325-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336413-075311500000X
CA336413-076311500000X
CA336413-077311500000X
CA336413-078311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA336413-075Medicaid