Signature Residence, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SIGNATURE RESIDENCE, INC

Practice address

2727 Wavecrest Dr
Corona del Mar, CA 92625-1326

Phone

(949) 220-1412

NPI assigned

Feb 14, 2020

Last updated

Feb 14, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kolaleh Faris

Title

President

Phone

(949) 510-5968

Specialties & licenses 1

Addresses

Other names 1

• Signature Residence, Inc Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581638400000",
    "number": "1063045391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2727 WAVECREST DR",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926251326",
            "telephone_number": "949-220-1412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 WAVECREST DR",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926251326",
            "telephone_number": "949-220-1412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIGNATURE RESIDENCE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-14",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A",
        "authorized_official_last_name": "FARIS",
        "authorized_official_first_name": "KOLALEH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-510-5968"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Signature Residence, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Assisted Living Facility in Corona del Mar, CA
• Providers in Corona del Mar, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.