Healthcare Provider Details

I. General information

NPI: 1598676033
Provider Name (Legal Business Name): BALBOA SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 N FIRESIDE ST
ORANGE CA
92867-4015
US

IV. Provider business mailing address

1669 N FIRESIDE ST
ORANGE CA
92867-4015
US

V. Phone/Fax

Practice location:
  • Phone: 949-994-2900
  • Fax: 714-333-4412
Mailing address:
  • Phone: 949-994-2900
  • Fax: 714-333-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: AHMED ATTRAH
Title or Position: ADMINISTRATOR
Credential:
Phone: 949-994-2900