Healthcare Provider Details

I. General information

NPI: 1497514558
Provider Name (Legal Business Name): KINGSWORK SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 02/07/2026
Certification Date: 02/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4253 LADRILLO ST
LAKE ELSINORE CA
92530-7603
US

IV. Provider business mailing address

6597 LUNT CT
CHINO CA
91710-7382
US

V. Phone/Fax

Practice location:
  • Phone: 909-896-4539
  • Fax:
Mailing address:
  • Phone: 909-896-4539
  • Fax:

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: MR. RANDOLPH HABER PAYAWAL
Title or Position: CEO
Credential:
Phone: 909-896-4539