Organization
MIRABEL LODGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER VARSHAVSKY (LICENSEE)
(415) 264-5486
Entity
Organization
Contact information
Practice address
6950 MIRABEL RD, FORESTVILLE, CA 95436-9534
(415) 264-5486
Mailing address
6950 MIRABEL RD, FORESTVILLE, CA 95436-9534
(415) 264-5486
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
10/12/2022
Last updated
10/12/2022
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