# COLLINGWOOD MANOR LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Collingwood Manor
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366518524
- **Authorized official:** MS. MARY P MILLER (CHIEF LEGAL COUNSEL)
- **Authorized official phone:** (619) 441-8771

## Contact information

- **Practice address:** 553 F STREET, CHULA VISTA, CA 91910-3515
- **Practice address phone:** (619) 426-8611
- **Practice address fax:** (619) 426-2315
- **Mailing address:** 553 F STREET, CHULA VISTA, CA 91910-3515
- **Mailing address phone:** (619) 426-8611
- **Mailing address fax:** (619) 426-2315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 090000120 | CA | Yes |

## Other

- **Enumeration date:** 11/28/2006
- **Last updated:** 01/13/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT 11310G | — | CA |