Provider Demographics
NPI:1154695880
Name:FOUNTAINS SEA BLUFFS, SL, LP
Entity type:Organization
Organization Name:FOUNTAINS SEA BLUFFS, SL, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-234-3001
Mailing Address - Street 1:25411 SEA BLUFFS DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2190
Mailing Address - Country:US
Mailing Address - Phone:949-234-3001
Mailing Address - Fax:949-489-8159
Practice Address - Street 1:25411 SEA BLUFFS DR
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2190
Practice Address - Country:US
Practice Address - Phone:949-234-3001
Practice Address - Fax:949-489-8159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306004270310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA306004270OtherRCFE LICENSE NUMBER