Healthcare Provider Details

I. General information

NPI: 1669334058
Provider Name (Legal Business Name): MAGNOLIA CONGREGATE LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1572 EVERGREEN LN
CORONA CA
92879-3010
US

IV. Provider business mailing address

1438 STRATTFORD ST
BREA CA
92821-2169
US

V. Phone/Fax

Practice location:
  • Phone: 562-301-8792
  • Fax:
Mailing address:
  • Phone: 951-339-8190
  • Fax: 951-339-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CINDY LE
Title or Position: OWNER
Credential: NP
Phone: 562-301-8792