SHADED ARBOR LLC NPI 1003213950

NPI Information

NPI: 1003213950
Provider Name: SHADED ARBOR LLC
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
1412 GROVELAND TER
EL CAJON, CA
ZIP 92021
Phone: (619) 631-7000
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SHADED ARBOR LLC is an assisted living facility in El Cajon, CA. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. SHADED ARBOR LLC NPI is 1003213950. The provider is registered as an organization entity type.

The provider's business location address is:

1412 GROVELAND TER
EL CAJON, CA
ZIP 92021-418
Phone: (619) 631-7000
Fax: (619) 631-7591

The provider's authorized official is Richard Mutka .
The authorized official title is Owner and has the following contact phone number (951) 961-7410.

The enumeration date for this NPI number is 11/20/2014 and was last updated on 11/20/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		374603523	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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