Healthcare Provider Details

I. General information

NPI: 1699633644
Provider Name (Legal Business Name): SUMMERBREEZE CONGREGATE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13579 DARWIN DR
MORENO VALLEY CA
92555-2531
US

IV. Provider business mailing address

13579 DARWIN DR
MORENO VALLEY CA
92555-2531
US

V. Phone/Fax

Practice location:
  • Phone: 951-618-8819
  • Fax:
Mailing address:
  • Phone: 951-618-8819
  • 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. LAWRENCE C CARDENAS
Title or Position: OWNER
Credential:
Phone: 562-655-6545