Provider Demographics
NPI:1013125749
Name:MICHAELS PROJECT INC
Entity Type:Organization
Organization Name:MICHAELS PROJECT INC
Other - Org Name:PATHWAYS 2 ICF DDN
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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 1:1132 GULF DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-7716
Mailing Address - Country:US
Mailing Address - Phone:707-422-3061
Mailing Address - Fax:707-422-3062
Practice Address - Street 1:1132 GULF DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-7716
Practice Address - Country:US
Practice Address - Phone:707-422-3061
Practice Address - Fax:707-422-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80163GOtherMEDI-CAL PROVIDER NUMBER