Healthcare Provider Details

I. General information

NPI: 1275448482
Provider Name (Legal Business Name): SAN JACINTO ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 E MAIN ST
SAN JACINTO CA
92583-4231
US

IV. Provider business mailing address

397 E MAIN ST
SAN JACINTO CA
92583-4231
US

V. Phone/Fax

Practice location:
  • Phone: 855-627-4775
  • Fax: 866-627-4771
Mailing address:
  • Phone: 855-627-4775
  • Fax: 866-627-4771

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: MR. ERICKSON G TUMALIUAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 951-391-5040