Healthcare Provider Details

I. General information

NPI: 1336059369
Provider Name (Legal Business Name): AERIS CONGREGATE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 N VALLEJO WAY
UPLAND CA
91786-3052
US

IV. Provider business mailing address

1213 N VALLEJO WAY
UPLAND CA
91786-3052
US

V. Phone/Fax

Practice location:
  • Phone: 714-408-8996
  • Fax: 951-625-3967
Mailing address:
  • Phone: 714-408-8996
  • Fax: 951-625-3967

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: TOBY MICLAT
Title or Position: LLC MEMBER
Credential:
Phone: 714-408-8996