Organization
MICHAELS PROJECT INC
Active
Other names
Pathways 2 ICF DDN
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELINE CUEVA LVN (LICENSEE)
(707) 342-1770
Entity
Organization
Contact information
Practice address
1132 GULF DR, FAIRFIELD, CA 94533-7716
(707) 422-3061
(707) 422-3062
Mailing address
1132 GULF DR, FAIRFIELD, CA 94533-7716
(707) 422-3061
(707) 422-3062
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC80163G
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
05/18/2007
Last updated
08/22/2020
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