Organization
MICHAELS PROJECT INC
Active
Other names
Pathways 1 ICF DDN
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELINE CUEVA LVN (LICENSEE)
(707) 342-1770
Entity
Organization
Contact information
Practice address
1152 HICKORY AVE, FAIRFIELD, CA 94533-7094
(707) 428-1534
(707) 428-0627
Mailing address
1152 HICKORY AVE, FAIRFIELD, CA 94533-7094
(707) 428-1534
(707) 428-0627
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC80067G
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
05/16/2007
Last updated
08/22/2020
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