MEDICARE: LOVING HEART ASSISTED LIVING

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

General Provider Information

NPI Number	:	1417787789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING HEART ASSISTED LIVING

Provider Business Mailing Address
First Line	:	4475 DEL MAR AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-3618
Country	:	US
Telephone Number	:	909-709-5646
Fax Number	:

Provider Business Practice Location Address
First Line	:	4430 LOWELL ST
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-9113
Country	:	US
Telephone Number	:	833-216-0768
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	HENRY A RICHARDSON
Credential	:
Telephone Number	:	909-709-5646

Provider Enumeration Date	:	08/02/2024
Last Update Date	:	08/02/2024

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Directions to “LOVING HEART ASSISTED LIVING ” Practice Location

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