Healthcare Provider Details

I. General information

NPI: 1366871287
Provider Name (Legal Business Name): FRONT PORCH COMMUNITIES AND SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 THIRD AVE
CHULA VISTA CA
91910-1822
US

IV. Provider business mailing address

2185 N CALIFORNIA BLVD STE 215
WALNUT CREEK CA
94596-3566
US

V. Phone/Fax

Practice location:
  • Phone: 619-427-2777
  • Fax: 619-427-0394
Mailing address:
  • Phone: 415-823-5354
  • Fax: 925-956-7360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number374600802
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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