=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912874785
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRONT PORCH COMMUNITIES AND SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2025
-----------------------------------------------------
Last Update Date | 10/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2404 LORING ST
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92109-2347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-274-4110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2404 LORING ST
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92109-2347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR DIR REGULATORY & LICENSING
-----------------------------------------------------
Name | GRANT EDELSTONE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-322-9487
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------