MEDICARE: FRONT PORCH COMMUNITIES AND SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	197602346	CA
2	314000000X	Skilled Nursing Facility	970000015	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396821971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONT PORCH COMMUNITIES AND SERVICES

Provider Business Mailing Address
First Line	:	1055 N KINGSLEY DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1207
Country	:	US
Telephone Number	:	323-661-1128
Fax Number	:	323-661-4121

Provider Business Practice Location Address
First Line	:	1055 N KINGSLEY DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1207
Country	:	US
Telephone Number	:	323-661-1128
Fax Number	:	323-661-4121

Authorized Official
Title or Position	:	SR. DIRECTOR RISK MANAGEMENT
Name	:	GRANT EDELSTONE
Credential	:
Telephone Number	:	925-956-7360

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/29/2021

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Directions to “FRONT PORCH COMMUNITIES AND SERVICES ” Practice Location

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