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General NPI Number Information
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NPI Number | 1639539695
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Entity Type | Organization
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Legal Business Name | CRESENCIA CARE HOME LLC
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 1785 HONORS LN
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City | CORONA
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State | CA
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Zip | 92883-0759
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Country | US
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Telephone | 951-427-5086
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Fax | 951-547-1369
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Provider Business Mailing Address
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Address Line | 1785 HONORS LN
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City | CORONA
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State | CA
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Zip | 92883-0759
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Country | US
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Telephone | 951-427-5086
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Fax | 951-547-1369
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MR. RESTITUTO LUMBA CALILUNG
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Credential |
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Telephone | 714-906-6046
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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 | 336427417
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License Number State | CA
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