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General NPI Number Information
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NPI Number | 1528419207
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Entity Type | Organization
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Legal Business Name | A FAITHFUL HOME LLC
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Dates
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Enumeration Date | 06/24/2016
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Last Update Date | 06/24/2016
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Provider Practice Location Address
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Address Line | 26642 SALAMANCA DR
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City | MISSION VIEJO
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State | CA
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Zip | 92691-4923
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Country | US
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Telephone | 949-382-2818
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Fax | 949-382-2818
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Provider Business Mailing Address
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Address Line | 26642 SALAMANCA DR
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City | MISSION VIEJO
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State | CA
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Zip | 92691-4923
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Country | US
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Telephone | 949-382-2818
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Fax | 949-382-2818
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Authorized Official
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Title or Position | ADMINISTRATOR/LICENSEE
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Name | MS. THERESA SERAPIO KHOLOMA
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Credential |
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Telephone | 714-300-8055
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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 | 306004810
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License Number State | CA
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