Provider Demographics
NPI:1457049108
Name:LEMON GROVE TERRACE
Entity Type:Organization
Organization Name:LEMON GROVE TERRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:ARENAS
Authorized Official - Last Name:MENESES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:619-302-4210
Mailing Address - Street 1:8554 CALLE NORTE
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-3301
Mailing Address - Country:US
Mailing Address - Phone:619-302-4210
Mailing Address - Fax:619-303-4060
Practice Address - Street 1:8554 CALLE NORTE
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-3301
Practice Address - Country:US
Practice Address - Phone:619-302-4210
Practice Address - Fax:619-303-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility