Organization
GREEN LIFE LEGACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVELYN M MUGAR (ADMINISTRATOR)
(951) 570-0749
Entity
Organization
Contact information
Practice address
633 E BASELINE RD, CLAREMONT, CA 91711-2270
(951) 570-0749
Mailing address
633 E BASELINE RD, CLAREMONT, CA 91711-2270
(951) 570-0749
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
04/06/2014
Last updated
04/06/2014
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