1275187700 NPI number — CARE JORDAN SENIOR HOMES, LLC

Table of content: (NPI 1275187700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275187700 NPI number — CARE JORDAN SENIOR HOMES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE JORDAN SENIOR HOMES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275187700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17111 SAGA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORBA LINDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92886-3629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-203-1342
Provider Business Mailing Address Fax Number:
714-982-3348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8728 CANARY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-6353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
657-301-2629
Provider Business Practice Location Address Fax Number:
714-982-3348
Provider Enumeration Date:
08/01/2019

Additional Information

Authorized Official

Authorized Official Last Name:
LIMPIADO
Authorized Official First Name:
GIDEON
Authorized Official Middle Name:
GINACAY
Authorized Official Title or Position:
LICENSEE/ADMINISTRATOR
Authorized Official Telephone Number:
562-365-4155

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 306005439 . This is a "RCFE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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