MEDICARE: LOVING LEGENDS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	251X00000X	Supports Brokerage Agency
3	177F00000X	Lodging Provider
4	251B00000X	Case Management Agency
5	385H00000X	Respite Care

General Provider Information

NPI Number	:	1821827742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING LEGENDS LLC

Provider Business Mailing Address
First Line	:	750 S LINCOLN AVE STE 464
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92882-3551
Country	:	US
Telephone Number	:	951-545-7203
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 E MISSION PL
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-2829
Country	:	US
Telephone Number	:	951-545-7203
Fax Number	:	626-227-0626

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. SHAVONDA GREENE
Credential	:	DHA
Telephone Number	:	951-545-7203

Provider Enumeration Date	:	07/30/2024
Last Update Date	:	07/02/2026

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Directions to “LOVING LEGENDS LLC ” Practice Location

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