Healthcare Provider Details

I. General information

NPI: 1518504786
Provider Name (Legal Business Name): FAITH HOPE AND LOVE ASSISTED LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 VIA SAN JACINTO
RIVERSIDE CA
92506-3652
US

IV. Provider business mailing address

5505 VIA SAN JACINTO
RIVERSIDE CA
92506-3652
US

V. Phone/Fax

Practice location:
  • Phone: 909-263-7875
  • Fax: 951-781-7535
Mailing address:
  • Phone: 909-263-7875
  • Fax: 951-781-7535

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: BRIAN CONCANNON
Title or Position: PRESIDENT
Credential:
Phone: 909-263-7875