=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518639723
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRONT PORCH COMMUNITIES AND SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2021
-----------------------------------------------------
Last Update Date | 10/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1055 N KINGSLEY DR
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90029-1207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-661-1128
-----------------------------------------------------
Fax | 323-660-4091
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2185 N CALIFORNIA BLVD STE 215
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94596-3566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-956-7360
-----------------------------------------------------
Fax | 925-956-7360
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR. DIR. RISK MANAGEMENT
-----------------------------------------------------
Name | GRANT EDELSTONE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-956-7360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------