# MISSION LODGE SANITARIUM LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184924953
- **Authorized official:** MR. BRIAN K. REYNOLDS (MANAGER)
- **Authorized official phone:** (410) 513-8738

## Contact information

- **Practice address:** 824 S GLADYS AVE, SAN GABRIEL, CA 91776-2710
- **Practice address phone:** (626) 287-0753
- **Mailing address:** 1423 CLARKVIEW RD, BALTIMORE, MD 21209-2134
- **Mailing address phone:** (410) 427-2700
- **Mailing address fax:** (414) 815-5558

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | — | — |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 10/27/2010
- **Last updated:** 06/10/2015