Healthcare Provider Details

I. General information

NPI: 1336054949
Provider Name (Legal Business Name): TEMECULA CONGREGATE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34038 TURTLE CREEK ST
TEMECULA CA
92592-5643
US

IV. Provider business mailing address

34038 TURTLE CREEK ST
TEMECULA CA
92592-5643
US

V. Phone/Fax

Practice location:
  • Phone: 626-221-8801
  • Fax: 818-688-0272
Mailing address:
  • Phone: 626-221-8801
  • Fax: 818-688-0272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SHERWIN BANZUELA
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-221-8801