MEDICARE: FRONT PORCH COMMUNITIES OPERATING GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	197608482	CA

General Provider Information

NPI Number	:	1194130005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONT PORCH COMMUNITIES OPERATING GROUP, LLC

Provider Business Mailing Address
First Line	:	800 N BRAND BLVD
Second Line	:	19TH FLOOR
City	:	GLENDALE
State	:	CA
Zip	:	91203-1245
Country	:	US
Telephone Number	:	818-254-4100
Fax Number	:	818-254-4101

Provider Business Practice Location Address
First Line	:	1055 N KINGSLEY DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1207
Country	:	US
Telephone Number	:	323-661-1128
Fax Number	:	323-661-4121

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERTA JACOBSEN
Credential	:
Telephone Number	:	818-729-8100

Provider Enumeration Date	:	06/30/2014
Last Update Date	:	06/30/2014

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