Healthcare Provider Details

I. General information

NPI: 1740101989
Provider Name (Legal Business Name): SAN DIMAS OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 CYPRESS WAY
SAN DIMAS CA
91773-3708
US

IV. Provider business mailing address

801 CYPRESS WAY
SAN DIMAS CA
91773-3708
US

V. Phone/Fax

Practice location:
  • Phone: 562-450-1090
  • Fax: 562-450-1090
Mailing address:
  • Phone: 562-450-1090
  • 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: NIRJARA ACHARYA
Title or Position: VPO
Credential:
Phone: 562-450-1090