Healthcare Provider Details

I. General information

NPI: 1114830395
Provider Name (Legal Business Name): ACE CONGREGATE LIVING HEALTH FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23293 MONTALVO RD
MORENO VALLEY CA
92557-3514
US

IV. Provider business mailing address

23293 MONTALVO RD
MORENO VALLEY CA
92557-3514
US

V. Phone/Fax

Practice location:
  • Phone: 909-268-4181
  • Fax:
Mailing address:
  • Phone: 909-268-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHARITY C EZEAMAMA
Title or Position: ADMINISTRATOR
Credential: PA-C
Phone: 909-268-4181