Organization
SOUTH CAPITOL COTTAGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CAROL FRAZIER LVN (PRESIDENT)
(951) 662-3026
Entity
Organization
Contact information
Practice address
15054 DAISY RD, ADELANTO, CA 92301-4824
(951) 662-3026
Mailing address
1801 DE CARMEN DR, COLTON, CA 92324-6248
(951) 662-3026
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6310014738
—
CA
Enumeration date
01/21/2007
Last updated
09/01/2015
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