Provider Demographics
NPI:1457547820
Name:QUAIL PARK RETIREMENT VILLAGE LLC
Entity type:Organization
Organization Name:QUAIL PARK RETIREMENT VILLAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-624-3500
Mailing Address - Street 1:4520 W CYPRESS AVENUE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277
Mailing Address - Country:US
Mailing Address - Phone:559-624-3500
Mailing Address - Fax:559-624-3535
Practice Address - Street 1:4520 W CYPRESS AVENUE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-624-3500
Practice Address - Fax:559-624-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility