Provider Demographics
NPI: | 1760851232 |
---|---|
Name: | CANYON HILL SENIOR HOME I |
Entity Type: | Organization |
Organization Name: | CANYON HILL SENIOR HOME I |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | EDNA |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | ALBERTO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 858-689-9557 |
Mailing Address - Street 1: | 7241 CANYON HILL CT |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN DIEGO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92126-2050 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 858-774-3375 |
Mailing Address - Fax: | 858-693-6920 |
Practice Address - Street 1: | 7241 CANYON HILL CT |
Practice Address - Street 2: | |
Practice Address - City: | SAN DIEGO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92126-2050 |
Practice Address - Country: | US |
Practice Address - Phone: | 858-774-3375 |
Practice Address - Fax: | 858-693-6920 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-09-15 |
Last Update Date: | 2015-09-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 374601180 | 310400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |