Fontana Healthcare, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FONTANA HEALTHCARE, LLC

Doing business as

Casa Maria Healthcare Center

Practice address

17933 San Bernardino Ave
Fontana, CA 92335-6151

Phone

(909) 877-1555

NPI assigned

Nov 6, 2006

Last updated

Aug 22, 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

Mrs. Jeoung Lee

Title

President Ceo

Phone

(805) 494-1233

Specialties & licenses 1

Addresses

Other names 1

• CASA MARIA HEALTHCARE CENTER Doing business as

Locations

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114096120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 FAIRVIEW RD",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913612456",
            "telephone_number": "805-494-1233",
            "fax_number": "805-494-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17933 SAN BERNARDINO AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923356151",
            "telephone_number": "909-877-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FONTANA HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JEOUNG",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "805-494-1233",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CASA MARIA HEALTHCARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Fontana, CA
• Providers in Fontana, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.