Healthcare Provider Details

I. General information

NPI: 1821827742
Provider Name (Legal Business Name): LOVING LEGENDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E MISSION PL
CORONA CA
92879-2829
US

IV. Provider business mailing address

750 S LINCOLN AVE STE 464
CORONA CA
92882-3551
US

V. Phone/Fax

Practice location:
  • Phone: 951-545-7203
  • Fax: 626-227-0626
Mailing address:
  • Phone: 951-545-7203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAVONDA GREENE
Title or Position: ADMINISTRATOR
Credential: DHA
Phone: 951-545-7203