Provider Demographics
NPI:1700283348
Name:ROLLING MEADOWS CARE HOMES, INC
Entity Type:Organization
Organization Name:ROLLING MEADOWS CARE HOMES, INC
Other - Org Name:HAWKINS SUITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:RETZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-994-5048
Mailing Address - Street 1:PO BOX 90155
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92169-2155
Mailing Address - Country:US
Mailing Address - Phone:619-994-5048
Mailing Address - Fax:760-233-8917
Practice Address - Street 1:1723 CASERO PL
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4215
Practice Address - Country:US
Practice Address - Phone:760-294-3877
Practice Address - Fax:760-233-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374603436310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility