Organization
DOROTHY FAYE ALEXANDER
Active
Other names
GRANNY'S HOUSE - Magnolia Rd
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DOROTHY FAYE ALEXANDER (OWNER LICENSEE)
(530) 589-0536
Entity
Organization
Contact information
Practice address
632 MAGNOLIA RD, MARYSVILLE, CA 95901-3008
(530) 589-0536
(530) 589-1602
Mailing address
350 PLUMAS DR, OROVILLE, CA 95966-9241
(530) 589-0536
(530) 589-1602
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC60994F
CA MEDI CAL VENDOR #
CA
Enumeration date
02/13/2007
Last updated
08/22/2020
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