Provider Demographics
NPI:1871920090
Name:ROXIES ELDERLY HOMES
Entity type:Organization
Organization Name:ROXIES ELDERLY HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:GALANG
Authorized Official - Last Name:ROXAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:760-859-6303
Mailing Address - Street 1:929 CHUMASH TRL
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-1010
Mailing Address - Country:US
Mailing Address - Phone:760-859-6303
Mailing Address - Fax:760-509-4208
Practice Address - Street 1:929 CHUMASH TRL
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-1010
Practice Address - Country:US
Practice Address - Phone:760-859-6303
Practice Address - Fax:760-509-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374603238261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service