PCM GROUP INC DBA MIRABEL LODGE (NPI# 1336412113) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336412113 |
| Entity Type | Organization |
| Organization Name | PCM GROUP INC DBA MIRABEL LODGE |
| Practice Address |
6950 Mirabel Rd Forestville CA 95436-9534 |
| Mailing Address |
Po Box 1579 Forestville CA 95436-1579 |
| Practice Telephone | 7078871754 |
| Practice Fax Number | 7078870546 |
| Mailing Telephone | 7078871754 |
| Mailing Fax Number | 7078870546 |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2012-02-09 |
| Authorized Official Name | MR. ALAIN A SERKISSIAN (OWNER/ ADMINISTRATOR/ LICENCEE) |
| Authorized Official Telephone | 7078871754 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 310400000X | Assisted Living Facility | 496800941 | CA | Nursing & Custodial Care Facilities |
| N | 3104A0630X |
Assisted Living Facility Specialization: Assisted Living, Behavioral Disturbances |
496800941 | CA | Nursing & Custodial Care Facilities |
| Y | 311500000X | Alzheimer Center (Dementia Center) | 496800941 | CA | Nursing & Custodial Care Facilities |
| Street Address |
6950 MIRABEL RD |
| City | FORESTVILLE |
| State | CA |
| Zip Code | 95436-9534 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558483701 | Karol Hoff Scheiner | Dentist | 6625 Front St., Forestville, CA 95436 | 2007-04-06 |
| 1215947882 | Thomas Frederick Yatteau | Family Medicine | 6550 Front Street, Forestville, CA 95436 | 2006-08-08 |
| 1386633782 | Christopher Jason Hilton | Nurse Anesthetist, Certified Registered | 7232 Ellen Lane, Forestville, CA 95436 | 2005-10-18 |
| 1659630036 | West County Health Centers, Inc. | Clinic/Center | 6550 Front Street, Forestville, CA 95436-0000 | 2012-05-07 |
| 1922331644 | Empire Drug Company Inc. | Pharmacy | 6652 Front Street, Forestville, CA 95436-0189 | 2009-09-14 |
| 1134141781 | El Molino Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 6652 Front St, Forestville, CA 95436-0189 | 2006-07-24 |
| 1790055036 | Sever Effectiveness Strategies Inc | Clinic/Center | 6478 Mirabel Road, Forestville, CA 95436-1483 | 2012-01-04 |
| 1972662278 | Mark Joseph Sever | Physical Therapist | 6478 Mirabel Rd, Forestville, CA 95436-1483 | 2006-12-06 |
| 1487703013 | Thomas Patrick Murphy | Chiropractor | 6685 Front Street, Forestville, CA 95436-1518 | 2007-01-10 |
| 1316072424 | Richard Rosen Acupuncture, Inc. | Acupuncturist | 6544 Front St., Forestville, CA 95436-1713 | 2007-02-22 |
| Find all providers in zip 95436 | ||||
| Taxonomy Code | 311500000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Alzheimer Center (Dementia Center) |
| A freestanding facility or special care unit of a long term care facility focusing on patient care of individuals diagnosed with dementia or Alzheimer’s Disease or their related diseases. Six elements of the facility/unit set it apart from other (the rest of the) facilities(y): Admission of residents with dementia (including those with Alzheimer's disease); Staff who are specially selected, trained, and supervised; Activities that are specifically designed for the cognitively impaired; A marketing of a special care unit in brochures; A high level of family involvement; and A physical environment designed to keep residents safe and segregated from other populations. |
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|---|---|---|---|---|
| 1104425925 | Pacifica Newport Mesa LLC | Alzheimer Center (Dementia Center) | 2891 Bear St, Costa Mesa, CA 92626-4306 | 2020-10-22 |
| 1992304729 | Pacifica Riverside Sl Lp | Alzheimer Center (Dementia Center) | 6280 Clay St, Riverside, CA 92509-6005 | 2020-10-22 |
| 1235738071 | Pacifica Valley Crest Lp | Alzheimer Center (Dementia Center) | 18524 Corwin Rd, Apple Valley, CA 92307-2302 | 2020-10-22 |
| 1255930095 | Pacifica Senior Living Vacaville LLC | Alzheimer Center (Dementia Center) | 431 Nut Tree Rd, Vacaville, CA 95687-3508 | 2020-10-22 |
| 1689273401 | St Pauls Modesto Lp | Alzheimer Center (Dementia Center) | 2325 St Pauls Way, Modesto, CA 95355-3309 | 2020-10-22 |
| 1295332047 | Rvmur Operations Company | Alzheimer Center (Dementia Center) | 24271 Jackson Ave, Murrieta, CA 92562-1993 | 2020-10-05 |
| 1356980494 | Memory Spa, LLC | Alzheimer Center (Dementia Center) | 1950 Sunny Crest Dr Ste 1400, Fullerton, CA 92835-3642 | 2020-01-06 |
| 1851940308 | Vista Prado Inc | Alzheimer Center (Dementia Center) | 105 Power Dr, Vallejo, CA 94589-2529 | 2019-09-07 |
| 1821641507 | Ktre1, LLC | Alzheimer Center (Dementia Center) | 3219 Canon St, San Diego, CA 92106-2512 | 2019-07-22 |
| 1497229090 | Ktre3, LLC | Alzheimer Center (Dementia Center) | 7971 Culowee St, La Mesa, CA 91942-5509 | 2019-01-16 |
| Find all providers with the same taxonomy | ||||
| City | FORESTVILLE |
| Zip Code | 95436 |
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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.