Organization
PCM GROUP INC DBA MIRABEL LODGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALAIN A SERKISSIAN (OWNER/ ADMINISTRATOR/ LICENCEE)
(707) 887-1754
Entity
Organization
Contact information
Practice address
6950 MIRABEL RD, FORESTVILLE, CA 95436-9534
(707) 887-1754
(707) 887-0546
Mailing address
PO BOX 1579, FORESTVILLE, CA 95436-1579
(707) 887-1754
(707) 887-0546
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
496800941
CA
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
496800941
CA
311500000X
Alzheimer Center (Dementia Center)
Primary
496800941
CA
Other
Enumeration date
02/09/2012
Last updated
02/09/2012
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