Provider Demographics
NPI:1639997547
Name:GARDEN LIVING AT ALPINE LLC
Entity type:Organization
Organization Name:GARDEN LIVING AT ALPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NUGUID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-618-0016
Mailing Address - Street 1:6053 FRED DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3905
Mailing Address - Country:US
Mailing Address - Phone:714-618-0016
Mailing Address - Fax:
Practice Address - Street 1:30875 AVENIDA JUAREZ
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-2989
Practice Address - Country:US
Practice Address - Phone:714-710-0587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility