MARK JORDAN AGRESOR (NPI# 1265971162) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265971162 |
| Entity Type | Individual |
| Full Name | MARK JORDAN AGRESOR |
| Practice Address |
4425 Camino Parocela Palm Springs CA 92264 |
| Mailing Address |
4425 E Camino Parocela Palm Springs CA 92264-1451 |
| Practice Telephone | 7604132998 |
| Mailing Telephone | 7604132998 |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2017-02-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 00859592 | CA | Nursing & Custodial Care Facilities |
| Street Address |
4425 CAMINO PAROCELA |
| City | PALM SPRINGS |
| State | CA |
| Zip Code | 92264 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154928679 | Carina Lopez | Technician, Other | 3065 E Ramon Rd, Palm Springs, CA 92264 | 2020-10-07 |
| 1538727466 | Sina Khanbabakhani | Dentist | 555 South Sunrise Way, Palm Springs, CA 92264 | 2019-06-05 |
| 1609329002 | Jeffrey Idica | Naturopath | 1775 E Palm Canyon Dr Ste 310, Palm Springs, CA 92264 | 2016-08-02 |
| 1609240605 | Brandon Hagar | Technician, Other | 3025 E Escoba Dr Apt 236, Palm Springs, CA 92264 | 2015-11-14 |
| 1861618852 | Jin Woo | Acupuncturist | 1001 S Palm Canyon Dr, Suite 105, Palm Springs, CA 92264 | 2007-04-18 |
| 1629114269 | Andrew Petras | Optometrist | 148 Eastlake Dr, Palm Springs, CA 92264 | 2007-01-30 |
| 1952453375 | Gina D Davis | Chiropractor | 4050 Airport Center Drive, Suite G, Palm Springs, CA 92264 | 2007-01-17 |
| 1548328834 | Michael R Gurk Ms Pt Apc | Physical Therapist | 1001 S Palm Canyon Drive, Ste 111, Palm Springs, CA 92264 | 2006-12-05 |
| 1750399747 | Lee Un A Professional Dental Corp | Dentist | 471 E Tahquitz Cyn Way #221, Palm Springs, CA 92264 | 2006-08-04 |
| 1124051651 | Palm Springs Hearing Aid Center | Specialist | 1555 S. Palm Canyon Dr., Suite D-103, Palm Springs, CA 92264 | 2006-07-08 |
| Find all providers in zip 92264 | ||||
| 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 |
|---|---|---|---|---|
| 1346849171 | Pacifica Sl Palm Springs LLC | Assisted Living Facility | 1780 E Baristo Rd, Palm Springs, CA 92262-7114 | 2020-10-22 |
| 1619447166 | Oasis Raquel Alf Inc | Assisted Living Facility | 3078 Drew Way, Palm Springs, FL 33406-7634 | 2018-11-27 |
| 1730531096 | Willie Junior Moyer IIi | Assisted Living Facility | 3055 E Escoba Dr, Palm Springs, CA 92264-5522 | 2016-07-11 |
| 1306217948 | Cri Enterprises, Inc. | Assisted Living Facility | 3140 E Vista Chino, Palm Springs, CA 92262-5475 | 2015-10-08 |
| 1790167682 | Blue Ribbon Care Assisted Living Facilty, LLC | Assisted Living Facility | 125 Ainsworth Cir, Palm Springs, FL 33461-2015 | 2015-06-26 |
| 1093158479 | Abaco House A.l.f,llc | Assisted Living Facility | 121 Abaco Dr, Palm Springs, FL 33461-2001 | 2013-04-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| Find all providers with the same taxonomy | ||||
| City | PALM SPRINGS |
| Zip Code | 92264 |
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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.