Provider Demographics
NPI:1336976778
Name:QUAIL LAKE HOLDINGS LLC
Entity type:Organization
Organization Name:QUAIL LAKE HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:
Authorized Official - Last Name:TILFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-774-8342
Mailing Address - Street 1:16544 FRANZEN FARM RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-2240
Mailing Address - Country:US
Mailing Address - Phone:858-798-5700
Mailing Address - Fax:
Practice Address - Street 1:9289 BRANSTETTER PL
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1700
Practice Address - Country:US
Practice Address - Phone:209-477-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility