Healthcare Provider Details

I. General information

NPI: 1447174156
Provider Name (Legal Business Name): MY SECOND HOME ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20884 SPRING ST
RIVERSIDE CA
92507-0161
US

IV. Provider business mailing address

22382 TESORO CT
GRAND TERRACE CA
92313-5669
US

V. Phone/Fax

Practice location:
  • Phone: 951-201-9267
  • Fax:
Mailing address:
  • Phone: 626-482-0957
  • 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: KENYA ALEJANDRA TORRES
Title or Position: ADMINISTRATOR
Credential:
Phone: 951-201-9267