Healthcare Provider Details

I. General information

NPI: 1861267395
Provider Name (Legal Business Name): HSRE PACIFICA HILLSBOROUGH TRS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11918 CENTRAL AVENUE
CHINO CA
91710
US

IV. Provider business mailing address

11918 CENTRAL AVENUE
CHINO CA
91710
US

V. Phone/Fax

Practice location:
  • Phone: 909-548-2100
  • Fax: 909-993-5079
Mailing address:
  • Phone: 909-548-2100
  • Fax: 909-993-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: DEEPAK ISRANI
Title or Position: GENERAL MANAGER
Credential:
Phone: 619-296-9000