Provider Demographics
NPI:1609288133
Name:MADDIGRL LLC
Entity Type:Organization
Organization Name:MADDIGRL LLC
Other - Org Name:MADELEINE'S SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TEOFILO
Authorized Official - Middle Name:POSADAS
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:619-934-7884
Mailing Address - Street 1:1248 ATWATER ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1453
Mailing Address - Country:US
Mailing Address - Phone:619-934-7884
Mailing Address - Fax:888-588-0942
Practice Address - Street 1:2880 WANEK RD
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-2889
Practice Address - Country:US
Practice Address - Phone:760-781-1027
Practice Address - Fax:888-588-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374603045310400000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient