NPIMap

Organization Active NPI

Extraordinary Living GP

  • Adult Care Home Facility
  • Perris, CA
National Provider Identifier
1073312005
Registry record updated Mar 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
Legal business name
EXTRAORDINARY LIVING GP
Practice address
4372 Almaterra Dr
Perris, CA 92571-5112
Phone
(562) 897-6041
NPI assigned
Mar 11, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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

Authorized official

Name
Jacquiece ParkerNPI 1154143808
Title
Administrator
Phone
(562) 897-6041

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X Primary

Addresses

Primary practice location

4372 Almaterra Dr
Perris, CA 92571-5112

Mailing address

4372 Almaterra Dr
Perris, CA 92571-5112
Phone (562) 897-6041

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1741651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741651200000",
    "number": "1073312005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4372 ALMATERRA DR",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925715112",
            "telephone_number": "562-897-6041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4372 ALMATERRA DR",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925715112",
            "telephone_number": "562-897-6041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTRAORDINARY LIVING GP",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-11",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "JACQUIECE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "562-897-6041"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perris, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; 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.