Provider Demographics
NPI:1063222982
Name:MEADOWBROOK PLACE ASSISTED LIVING
Entity type:Organization
Organization Name:MEADOWBROOK PLACE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:SAMSON
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-470-6457
Mailing Address - Street 1:461 E JOHNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-7113
Mailing Address - Country:US
Mailing Address - Phone:818-470-6457
Mailing Address - Fax:
Practice Address - Street 1:461 E JOHNSTON AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7113
Practice Address - Country:US
Practice Address - Phone:818-470-6457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility