Organization
EXTRAORDINARY LIVING GP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUIECE PARKER (ADMINISTRATOR)
(562) 897-6041
Entity
Organization
Contact information
Practice address
4372 ALMATERRA DR, PERRIS, CA 92571-5112
(562) 897-6041
Mailing address
4372 ALMATERRA DR, PERRIS, CA 92571-5112
(562) 897-6041
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
03/11/2025
Last updated
03/11/2025
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