Provider Demographics
NPI:1851075626
Name:PSALM 23 ASSISTED LIVING LLC
Entity type:Organization
Organization Name:PSALM 23 ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:GAWARAN
Authorized Official - Last Name:LACONSAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-610-8455
Mailing Address - Street 1:13536 DEL MARINO AVE
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5008
Mailing Address - Country:US
Mailing Address - Phone:858-610-8455
Mailing Address - Fax:
Practice Address - Street 1:9431 REAGAN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2203
Practice Address - Country:US
Practice Address - Phone:858-610-8455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home