Provider Demographics
NPI:1528747607
Name:BADDELEY, TERESA L
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:BADDELEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8430 I AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6963
Mailing Address - Country:US
Mailing Address - Phone:909-256-9819
Mailing Address - Fax:760-596-5375
Practice Address - Street 1:8430 I AVE
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6963
Practice Address - Country:US
Practice Address - Phone:909-256-9819
Practice Address - Fax:760-596-5375
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3661800121310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility