Healthcare Provider Details

I. General information

NPI: 1801749064
Provider Name (Legal Business Name): VITALBREATH CARE FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7817 SAUTERNE DR
RANCHO CUCAMONGA CA
91730-2410
US

IV. Provider business mailing address

6876 RIPPLE CT
JURUPA VALLEY CA
91752-2749
US

V. Phone/Fax

Practice location:
  • Phone: 714-745-2896
  • Fax:
Mailing address:
  • Phone: 714-745-2896
  • 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: JIMMY LU
Title or Position: OWNER
Credential:
Phone: 714-745-2896