Organization
SHADED ARBOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD MUTKA (OWNER)
(951) 961-7410
Entity
Organization
Contact information
Practice address
1412 GROVELAND TER, EL CAJON, CA 92021-3418
(619) 631-7000
(619) 631-7591
Mailing address
1412 GROVELAND TER, EL CAJON, CA 92021-3418
(619) 631-7000
(619) 631-7591
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
374603523
CA
Other
Enumeration date
11/20/2014
Last updated
11/20/2014
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