MEDICARE: FRONT PORCH COMMUNITIES OPERATING GROUP LLC

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1538416599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONT PORCH COMMUNITIES OPERATING GROUP LLC

Provider Business Mailing Address
First Line	:	800 N BRAND BLVD FL 19
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1231
Country	:	US
Telephone Number	:	818-254-4100
Fax Number	:	818-254-4101

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	:	323-660-4091

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERTA JACOBSEN
Credential	:
Telephone Number	:	818-254-4100

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	09/23/2015

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