Healthcare Provider Details

I. General information

NPI: 1538416599
Provider Name (Legal Business Name): FRONT PORCH COMMUNITIES OPERATING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N KINGSLEY DR
LOS ANGELES CA
90029-1207
US

IV. Provider business mailing address

800 N BRAND BLVD FL 19
GLENDALE CA
91203-1231
US

V. Phone/Fax

Practice location:
  • Phone: 323-661-1128
  • Fax: 323-660-4091
Mailing address:
  • Phone: 818-254-4100
  • Fax: 818-254-4101

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: ROBERTA JACOBSEN
Title or Position: PRESIDENT
Credential:
Phone: 818-254-4100