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General NPI Number Information
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NPI Number | 1619839941
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Entity Type | Organization
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Legal Business Name | THE HARVEST HOME LLC
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Dates
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Enumeration Date | 11/25/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 11915 BERLYN DOVE CT
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City | JURUPA VALLEY
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State | CA
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Zip | 91752-2927
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Country | US
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Telephone | 951-332-0421
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Fax | 951-332-0288
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Provider Business Mailing Address
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Address Line | 6885 CEDAR CREEK RD
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City | EASTVALE
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State | CA
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Zip | 92880-8805
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Country | US
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Telephone | 951-332-0421
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Fax | 951-332-0288
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Authorized Official
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Title or Position | OWNER
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Name | SIMM KESONE SANASINH
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Credential | ADMINISTRATOR
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Telephone | 949-233-1645
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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 |
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