MEDICARE: NEWPORT CONGREGATE 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1851010755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWPORT CONGREGATE LIVING

Provider Business Mailing Address
First Line	:	18791 MURIEL PL
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-2844
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	466 E 16TH ST
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-3266
Country	:	US
Telephone Number	:	714-679-0457
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MIRELA ANDRONESI
Credential	:
Telephone Number	:	714-679-0457

Provider Enumeration Date	:	08/24/2022
Last Update Date	:	08/24/2022

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Directions to “NEWPORT CONGREGATE LIVING ” Practice Location

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