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General NPI Number Information
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NPI Number | 1164334256
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Entity Type | Organization
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Legal Business Name | FULLERTON SH LLC
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 1925 SUNNY CREST DR
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City | FULLERTON
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State | CA
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Zip | 92835-3628
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Country | US
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Telephone | 714-992-1999
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Fax | 714-992-4186
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Provider Business Mailing Address
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Address Line | 1925 SUNNY CREST DR
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City | FULLERTON
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State | CA
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Zip | 92835-3628
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Country | US
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Telephone | 714-992-1999
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Fax | 714-992-4186
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Authorized Official
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Title or Position | VP OF BUSINESS
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Name | KYLE HIBBLER
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Credential |
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Telephone | 503-391-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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