Organization
3395493
Active
Organization
3395493
Active
Other names
St Simon Home II, St Simon Home
Organization subpart
No
Provider details
NPI number
Authorized official
DORSEY ROSE MARCHELLO (VICE PRESIDENT)
(714) 900-0694
Entity
Organization
Contact information
Practice address
4458 VIA DEL VALLE, YORBA LINDA, CA 92886-3021
(714) 900-0694
(714) 463-4403
Mailing address
18340 YORBA LINDA BLVD # 443, YORBA LINDA, CA 92886-4058
(714) 900-0694
(714) 463-4403
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
306004538
RCFE
CA
01
—
306004719
RCFE
CA
Enumeration date
12/06/2018
Last updated
12/06/2018
Update your record
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