Provider Demographics
NPI:1720616360
Name:LEWIS BAILEY RESIDENTIAL CARE FACILITY FOR THE ELDERLY L.L.C.
Entity Type:Organization
Organization Name:LEWIS BAILEY RESIDENTIAL CARE FACILITY FOR THE ELDERLY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TARI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-430-1921
Mailing Address - Street 1:26364 MALLORY CT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-3818
Mailing Address - Country:US
Mailing Address - Phone:951-430-1921
Mailing Address - Fax:951-430-4743
Practice Address - Street 1:26364 MALLORY CT
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-3818
Practice Address - Country:US
Practice Address - Phone:951-430-1921
Practice Address - Fax:951-430-4743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No385H00000XRespite Care FacilityRespite Care