Healthcare Provider Details

I. General information

NPI: 1669305330
Provider Name (Legal Business Name): WP ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9579 SEASONS DR
RANCHO CUCAMONGA CA
91730-6712
US

IV. Provider business mailing address

6305 NOBURY CT
EASTVALE CA
92880-8567
US

V. Phone/Fax

Practice location:
  • Phone: 657-722-9269
  • Fax:
Mailing address:
  • Phone: 657-722-9269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATSARA CHANTHARASETH
Title or Position: CEO
Credential:
Phone: 657-722-9269