Healthcare Provider Details

I. General information

NPI: 1043148679
Provider Name (Legal Business Name): ELLEE RESIDENTIAL CARE 5 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25708 OAK CT
MORENO VALLEY CA
92557-6628
US

IV. Provider business mailing address

502 CAJON ST
REDLANDS CA
92373-5904
US

V. Phone/Fax

Practice location:
  • Phone: 408-930-0790
  • Fax:
Mailing address:
  • Phone: 909-557-4422
  • 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: ALEX LENKE
Title or Position: ADMINISTRATOR
Credential:
Phone: 909-335-1818