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General NPI Number Information
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NPI Number | 1114830395
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Entity Type | Organization
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Legal Business Name | ACE CONGREGATE LIVING HEALTH FACILITY
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 23293 MONTALVO RD
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City | MORENO VALLEY
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State | CA
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Zip | 92557-3514
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Country | US
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Telephone | 909-268-4181
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Fax |
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Provider Business Mailing Address
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Address Line | 23293 MONTALVO RD
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City | MORENO VALLEY
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State | CA
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Zip | 92557-3514
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Country | US
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Telephone | 909-268-4181
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHARITY C EZEAMAMA
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Credential | PA-C
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Telephone | 909-268-4181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | NULL
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