Provider Demographics
NPI:1679907992
Name:QUEENS MANOR HOME CARE INC.
Entity Type:Organization
Organization Name:QUEENS MANOR HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/LICENSEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:TACAY
Authorized Official - Last Name:TOTANES
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:760-716-9301
Mailing Address - Street 1:1025 BONNIE BRAE PLACE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084
Mailing Address - Country:US
Mailing Address - Phone:760-216-8024
Mailing Address - Fax:760-806-9455
Practice Address - Street 1:1025 BONNIE BRAE PL
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5529
Practice Address - Country:US
Practice Address - Phone:760-806-9455
Practice Address - Fax:760-806-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374603285310400000X
CA374600710311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility