Provider Demographics
NPI:1619666492
Name:SELECT SENIOR CARE III LLC
Entity Type:Organization
Organization Name:SELECT SENIOR CARE III LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICNESEE
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DATCU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-358-1209
Mailing Address - Street 1:9542 SAILFISH DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2818
Mailing Address - Country:US
Mailing Address - Phone:909-358-1209
Mailing Address - Fax:
Practice Address - Street 1:9542 SAILFISH DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-2818
Practice Address - Country:US
Practice Address - Phone:909-358-1209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility