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
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