Provider Demographics
NPI:1710565908
Name:SANTA MARIANA CARE
Entity Type:Organization
Organization Name:SANTA MARIANA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-394-8708
Mailing Address - Street 1:18676 SANTA MARIANA ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6355
Mailing Address - Country:US
Mailing Address - Phone:949-394-8708
Mailing Address - Fax:
Practice Address - Street 1:18676 SANTA MARIANA ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6355
Practice Address - Country:US
Practice Address - Phone:949-394-8708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA306005845OtherRCFE CCLD