Healthcare Provider Details

I. General information

NPI: 1447069679
Provider Name (Legal Business Name): SOCAL RESPITE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6327 GIOVANNI WAY
PALMDALE CA
93551-1616
US

IV. Provider business mailing address

16604 TIMBERVIEW AVE
CHINO HILLS CA
91709-7844
US

V. Phone/Fax

Practice location:
  • Phone: 909-896-4539
  • Fax:
Mailing address:
  • Phone: 626-806-6655
  • 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: MAXMILLAN DE LOS SANTOS
Title or Position: CFO
Credential:
Phone: 626-806-6655