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General NPI Number Information
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NPI Number | 1285152629
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Entity Type | Organization
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Legal Business Name | SENIOR LIVING COMMUNITY AN EASTERN STAR HOME
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 16850 BASTANCHURY RD
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City | YORBA LINDA
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State | CA
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Zip | 92886-1608
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Country | US
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Telephone | 714-577-9281
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Fax | 714-577-9854
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Provider Business Mailing Address
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Address Line | 16850 BASTANCHURY RD
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City | YORBA LINDA
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State | CA
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Zip | 92886-1608
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Country | US
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Telephone | 714-577-9281
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Fax | 714-577-9854
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | MR. JIM WHITELEY
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Credential |
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Telephone | 707-696-7389
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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 | 306000889
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License Number State | CA
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