Healthcare Provider Details

I. General information

NPI: 1558204677
Provider Name (Legal Business Name): ADELANTO CARE MANOR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11653 OXFORD CT
ADELANTO CA
92301-3697
US

IV. Provider business mailing address

11653 OXFORD CT
ADELANTO CA
92301-3697
US

V. Phone/Fax

Practice location:
  • Phone: 442-249-1243
  • Fax:
Mailing address:
  • Phone: 442-249-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. OLIVER JALDO TANGUILAN
Title or Position: ADMINISTRATOR/ VP
Credential:
Phone: 657-282-2943