Healthcare Provider Details

I. General information

NPI: 1396377420
Provider Name (Legal Business Name): LOREN'S GOOD LIFE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16631 CANYON VIEW DR
RIVERSIDE CA
92504-6251
US

IV. Provider business mailing address

16631 CANYON VIEW DR
RIVERSIDE CA
92504-6251
US

V. Phone/Fax

Practice location:
  • Phone: 626-271-0490
  • Fax: 951-346-4090
Mailing address:
  • Phone: 626-271-0490
  • Fax: 951-346-4090

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: LOREN MC ELVAIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-271-0490