| Organization Name: | PCM GROUP INC DBA MIRABEL LODGE |
| NPI Number: | 1336412113 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALAIN A SERKISSIAN (OWNER/ ADMINISTRATOR/ LICENCEE) |
| Mailing Address: | 6950 Mirabel Rd Forestville |
| State: | CA US |
| Postal Code: | 954369534 |
| Phone Number: | 7078871754 |
| Fax Number: | 7078870546 |
| NPI Enumeration Date: | 02/09/2012 |
| NPI Last Update Date: | 02/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 310400000X |
| License Number: | 496800941 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Assisted Living Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | 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. |