Provider Demographics
NPI:1689971954
Name:WILDOMAR SENIOR PARTNERS II L.P.
Entity Type:Organization
Organization Name:WILDOMAR SENIOR PARTNERS II L.P.
Other - Org Name:WILDOMAR SENIOR ASSISTED LIVING FACILITY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:THRALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-678-1555
Mailing Address - Street 1:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-0740
Mailing Address - Country:US
Mailing Address - Phone:951-678-1555
Mailing Address - Fax:951-678-1249
Practice Address - Street 1:32365 S PASADENA
Practice Address - Street 2:ASSISTED LIVING
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-9551
Practice Address - Country:US
Practice Address - Phone:951-678-1555
Practice Address - Fax:951-678-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336407346310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility