Healthcare Provider Details

I. General information

NPI: 1083401665
Provider Name (Legal Business Name): SEQUOIA HEALTH & CARE RESIDENCE CONGREGATE CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13361 SEQUOIA RD
VICTORVILLE CA
92392-9796
US

IV. Provider business mailing address

13361 SEQUOIA RD
VICTORVILLE CA
92392-9796
US

V. Phone/Fax

Practice location:
  • Phone: 310-686-9676
  • Fax:
Mailing address:
  • Phone: 310-686-9676
  • Fax:

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: MISS JEANNETTE PHILLIPS
Title or Position: CEO
Credential: RN
Phone: 310-686-9676