Provider Demographics
NPI:1952687279
Name:MICHAEL'S PROJECT, INC
Entity Type:Organization
Organization Name:MICHAEL'S PROJECT, INC
Other - Org Name:PATHWAYS III
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:MICHELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:707-342-1770
Mailing Address - Street 1:1152 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-7094
Mailing Address - Country:US
Mailing Address - Phone:707-428-1534
Mailing Address - Fax:
Practice Address - Street 1:3038 PECAN CIR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-7013
Practice Address - Country:US
Practice Address - Phone:707-421-2338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility