Provider Demographics
NPI:1912915760
Name:BRIGHTON PLACE OF LA MESA
Entity Type:Organization
Organization Name:BRIGHTON PLACE OF LA MESA
Other - Org Name:PARKWAY HILLS NURSING AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-469-0124
Mailing Address - Street 1:7760 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2028
Mailing Address - Country:US
Mailing Address - Phone:619-469-0124
Mailing Address - Fax:619-469-6401
Practice Address - Street 1:7760 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2028
Practice Address - Country:US
Practice Address - Phone:619-469-0124
Practice Address - Fax:619-469-6401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKWAY HILLS NURSING AND REHA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-04
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000053314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05078HMedicaid
CA055078Medicare ID - Type Unspecified
CA5670930001Medicare Oscar/Certification
CA5670930001Medicare NSC
CA055078Medicare Oscar/Certification