Healthcare Provider Details

I. General information

NPI: 1194688069
Provider Name (Legal Business Name): ANTONY CARE HOMES 1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9433 GERANIUM CIR
FOUNTAIN VALLEY CA
92708-1920
US

IV. Provider business mailing address

9433 GERANIUM CIR
FOUNTAIN VALLEY CA
92708-1920
US

V. Phone/Fax

Practice location:
  • Phone: 714-883-3017
  • Fax:
Mailing address:
  • Phone: 714-883-3017
  • 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: DEVIN JOSHUA ANTONY
Title or Position: LICENSEE
Credential:
Phone: 714-883-3017