Basic Information
| Provider Information | |||||||||
| NPI: | 1902851488 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUREUS ACQUISITION I, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BRIGHTON GARDEN OF SAN DIMAS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 WESTPARK DR. | ||||||||
| Address2: | T-900, ATT: MEDICARE BILLING, M. GARCIA | ||||||||
| City: | MCLEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038540823 | ||||||||
| FaxNumber: | 7038540164 | ||||||||
| Practice Location | |||||||||
| Address1: | 1740 S SAN DIMAS AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIMAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917735108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093940304 | ||||||||
| FaxNumber: | 9093940903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 06/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | SPANN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9093940304 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 197803192 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.