Healthcare Provider Details

I. General information

NPI: 1851272801
Provider Name (Legal Business Name): CORTLAND CONGREGATE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 EL NIDO AVE
PERRIS CA
92571-3700
US

IV. Provider business mailing address

1637 EL NIDO AVE
PERRIS CA
92571-3700
US

V. Phone/Fax

Practice location:
  • Phone: 951-404-0531
  • Fax: 951-465-4594
Mailing address:
  • Phone: 951-404-0531
  • Fax: 951-465-4594

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: ADAM CORTLAND GREEN
Title or Position: OWNER
Credential:
Phone: 949-397-0658