Mirabel Lodge

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MIRABEL LODGE

Practice address

6950 Mirabel Rd
Forestville, CA 95436-9534

Phone

(415) 264-5486

NPI assigned

Oct 12, 2022

Last updated

Oct 12, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alexander Varshavsky

Title

Licensee

Phone

(415) 264-5486

Specialties & licenses 1

Addresses

Tax ID family

Mirabel Lodge2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Sonomamodelx Inc

  • Assisted Living Facility
  • Sonoma, CA
  • NPI 1750073136
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1366168296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6950 MIRABEL RD",
            "city": "FORESTVILLE",
            "state": "CA",
            "postal_code": "954369534",
            "telephone_number": "415-264-5486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6950 MIRABEL RD",
            "city": "FORESTVILLE",
            "state": "CA",
            "postal_code": "954369534",
            "telephone_number": "415-264-5486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRABEL LODGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-12",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "VARSHAVSKY",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "LICENSEE",
        "authorized_official_telephone_number": "415-264-5486"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Craig Steven Kleinman
• Shannon Lawee
• Katherine Mariad Lee
• Tasha Lopez
• Lilanya Manspeaker, OFMT
• Thomas Patrick Murphy, D.C.
• Richard Naegle, MSW, PHD
• Parallel Perspectives LLC
• Elena Parolini, MA, BCBA
• PCM Group Inc Dba Mirabel Lodge

• Assisted Living Facility in Forestville, CA
• Providers in Forestville, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.