Healthcare Provider Details

I. General information

NPI: 1396565024
Provider Name (Legal Business Name): 4JRM CARE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17455 MADRONE ST
FONTANA CA
92337-6855
US

IV. Provider business mailing address

1015 S SILVER STAR WAY
ANAHEIM CA
92808-2631
US

V. Phone/Fax

Practice location:
  • Phone: 909-251-4717
  • Fax:
Mailing address:
  • Phone: 714-267-0319
  • 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: MISS MARICEL GINETE CALMA
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-267-0319