Healthcare Provider Details

I. General information

NPI: 1013499912
Provider Name (Legal Business Name): CALIFORNIA MANOR GUEST HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 04/03/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8536 & 8548 CALIFORNIA AVE
RIVERSIDE CA
92504
US

IV. Provider business mailing address

8536 CALIFORNIA AVE
RIVERSIDE CA
92504-2854
US

V. Phone/Fax

Practice location:
  • Phone: 646-523-8208
  • Fax:
Mailing address:
  • Phone:
  • 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: NAJEH HAMED
Title or Position: CEO
Credential:
Phone: 786-219-6008