Healthcare Provider Details

I. General information

NPI: 1245149210
Provider Name (Legal Business Name): CEDAR BLOSSOM SENIOR LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5592 PHILADELPHIA ST
CHINO CA
91710-2467
US

IV. Provider business mailing address

5592 PHILADELPHIA ST
CHINO CA
91710-2467
US

V. Phone/Fax

Practice location:
  • Phone: 626-535-3137
  • Fax:
Mailing address:
  • Phone: 626-535-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MATTHEW LIBUCHA
Title or Position: CEO
Credential:
Phone: 626-535-3137