Provider Demographics
NPI:1760851232
Name:CANYON HILL SENIOR HOME I
Entity type:Organization
Organization Name:CANYON HILL SENIOR HOME I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALBERTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-689-9557
Mailing Address - Street 1:7241 CANYON HILL CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2050
Mailing Address - Country:US
Mailing Address - Phone:858-774-3375
Mailing Address - Fax:858-693-6920
Practice Address - Street 1:7241 CANYON HILL CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2050
Practice Address - Country:US
Practice Address - Phone:858-774-3375
Practice Address - Fax:858-693-6920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374601180310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility