MEDICARE: THEO'S PLACE, INC.

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

General Provider Information

NPI Number	:	1790636165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THEO'S PLACE, INC.

Provider Business Mailing Address
First Line	:	27101 IRONWOOD DR
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-6509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25011 DE SALLE ST
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5042
Country	:	US
Telephone Number	:	845-826-4438
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NEVIN NAJAROEN
Credential	:
Telephone Number	:	845-826-4438

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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