SHADED ARBOR LLC (NPI# 1003213950) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003213950 |
| Entity Type | Organization |
| Organization Name | SHADED ARBOR LLC |
| Practice Address |
1412 Groveland Ter El Cajon CA 92021-3418 |
| Practice Telephone | 6196317000 |
| Practice Fax Number | 6196317591 |
| Mailing Telephone | 6196317000 |
| Mailing Fax Number | 6196317591 |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2014-11-20 |
| Authorized Official Name | RICHARD MUTKA (OWNER) |
| Authorized Official Telephone | 9519617410 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 374603523 | CA | Nursing & Custodial Care Facilities |
| Street Address |
1412 GROVELAND TER |
| City | EL CAJON |
| State | CA |
| Zip Code | 92021-3418 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033728498 | Hala Kadhem | Counselor | 1664 Broadway, El Cajon, San Diego, CA 92021 | 2020-07-30 |
| 1891331021 | Medevac Inc | Ambulance | 8025 Tone Lane, El Cajon, CA 92021 | 2019-11-22 |
| 1760024095 | San Diego Health Alliance, Inc. | Clinic/Center | 1625 East Main Street, El Cajon, CA 92021 | 2019-10-08 |
| 1295388932 | Coleen Stacie Cobbs | Social Worker | 1013 Greta Street, El Cajon, CA 92021 | 2019-07-22 |
| 1144744475 | Sarah Kala | Pharmacist | 505 N Mollison Ave #102, El Cajon, CA 92021 | 2017-07-28 |
| 1699139816 | Mayra Aranda | Counselor | 1679 East Main Street, Suite 102, El Cajon, CA 92021 | 2016-04-13 |
| 1942603436 | Scott Crusey | Counselor | 1679 East Main Street, Suite 102, El Cajon, CA 92021 | 2014-09-29 |
| 1104254317 | Naimh Martin | Counselor | 1630 E Main Street, El Cajon, CA 92021 | 2013-10-25 |
| 1386875540 | Jacqueline Vu Luong | Marriage & Family Therapist | 1000 Broadway #100, El Cajon, CA 92021 | 2009-08-05 |
| 1740444264 | Peter Morhan Sun | General Practice | 7957 Bevin Lane, El Cajon, CA 92021 | 2008-07-14 |
| Find all providers in zip 92021 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| 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. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497103865 | Jocelyn De Jesus Tuason | Assisted Living Facility | 11945 Via Hacienda, El Cajon, CA 92019 | 2016-05-26 |
| 1104224153 | Good Samaritan Retirement Center | Assisted Living Facility | 1515 Jamacha Way, El Cajon, CA 92019-4123 | 2014-12-08 |
| 1104229012 | Granite Hills Senior Living, Inc. | Assisted Living Facility | 768 Dorothy St, El Cajon, CA 92019-3101 | 2014-10-06 |
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|---|---|---|---|---|
| 1710588165 | Nana's Garden II | Assisted Living Facility | 25312 Ericson Way, Laguna Hills, CA 92653-5054 | 2020-11-03 |
| 1609476589 | Southbay Care Home, Inc. | Assisted Living Facility | 19917 Anza Avenue, Torrance, CA 90503-2005 | 2020-10-29 |
| 1821697434 | Global Regency Senior Care Services, LLC | Assisted Living Facility | 117 E 8th St, Long Beach, CA 90813-4397 | 2020-10-23 |
| 1689273419 | Pacifica Slo LLC | Assisted Living Facility | 475 Marsh St, San Luis Obispo, CA 93401-6108 | 2020-10-22 |
| 1871192682 | Pacifica Sfo LLC | Assisted Living Facility | 624 Laguna St, San Francisco, CA 94102-4217 | 2020-10-22 |
| 1528667367 | Pacifica Sierra Vista Lp | Assisted Living Facility | 13815 Rodeo Dr, Victorville, CA 92395-5600 | 2020-10-22 |
| 1992304737 | West Lyons Lp | Assisted Living Facility | 24305 Lyons Ave, Newhall, CA 91321-2344 | 2020-10-22 |
| 1619576451 | Pacifica Orange County LLC | Assisted Living Facility | 2619 Orange Ave, Costa Mesa, CA 92627-4630 | 2020-10-22 |
| 1720687551 | P San Leandro Lp | Assisted Living Facility | 348 W Juana Ave, San Leandro, CA 94577-3661 | 2020-10-22 |
| 1952900730 | Pacifica Daly LLC | Assisted Living Facility | 995 E Market St, Daly City, CA 94014-2168 | 2020-10-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.