Healthcare Provider Details

I. General information

NPI: 1265518872
Provider Name (Legal Business Name): FRONT PORCH COMMUNITIES AND SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 CARLSBAD BLVD
CARLSBAD CA
92008-2902
US

IV. Provider business mailing address

2855 CARLSBAD BLVD
CARLSBAD CA
92008-2902
US

V. Phone/Fax

Practice location:
  • Phone: 760-720-4580
  • Fax: 760-729-0938
Mailing address:
  • Phone: 760-720-4580
  • Fax: 760-729-0938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number080000116
License Number StateCA

VIII. Authorized Official

Name: GRANT EDELSTONE
Title or Position: SR. DIRECTOR RISK MANAGEMENT
Credential:
Phone: 925-956-7360