Provider Demographics
NPI:1033941448
Name:ASSISTED LIVING AND MEMORY CARE HOME AT WILDROSE RANCH
Entity type:Organization
Organization Name:ASSISTED LIVING AND MEMORY CARE HOME AT WILDROSE RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NOELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-317-4773
Mailing Address - Street 1:2948 SONRISA DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3916
Mailing Address - Country:US
Mailing Address - Phone:951-317-4773
Mailing Address - Fax:951-739-0239
Practice Address - Street 1:22877 MOUNTAIN ASH CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-5006
Practice Address - Country:US
Practice Address - Phone:951-603-3042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility