Organization
IJT9112 AND ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD ANTHONY EDWARDS (HEALTHCARE ADMINISTRATOR)
(619) 954-0963
Entity
Organization
Contact information
Practice address
9112 WAKARUSA ST, LA MESA, CA 91942-3308
(619) 741-2499
Mailing address
9112 WAKARUSA ST, LA MESA, CA 91942-3308
(619) 741-2499
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
374603906
CA
Other
Enumeration date
04/17/2017
Last updated
12/28/2023
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