Healthcare Provider Details

I. General information

NPI: 1104902725
Provider Name (Legal Business Name): FRONT PORCH COMMUNITIES AND SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 E VILLA ST
PASADENA CA
91101-1259
US

IV. Provider business mailing address

842 E VILLA ST
PASADENA CA
91101-1259
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-8162
  • Fax: 626-568-9606
Mailing address:
  • Phone: 626-796-8162
  • Fax: 616-568-9606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number950000069
License Number StateCA

VIII. Authorized Official

Name: GRANT EDELSTONE
Title or Position: SR. DIRECTOR RISK MANAGEMENT
Credential:
Phone: 925-956-7360