Prime Senior Care Homes L.L.C

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PRIME SENIOR CARE HOMES L.L.C

Doing business as

Avalon Guest Home I

Practice address

1857 Sheddon St
Fullerton, CA 92833-5659

Phone

(714) 869-3532

Fax

(714) 869-3532

NPI assigned

Oct 20, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Maryam F Sharifi

Title

Administrator/Licensee

Phone

(949) 485-1376

Specialties & licenses 1

Addresses

Other names 1

• Avalon Guest Home I Doing business as

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

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1245839315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1857 SHEDDON ST",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928335659",
            "telephone_number": "714-869-3532",
            "fax_number": "714-869-3532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1857 SHEDDON ST",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928335659",
            "telephone_number": "714-869-3532",
            "fax_number": "714-869-3532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME SENIOR CARE HOMES L.L.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-20",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "SHARIFI",
        "authorized_official_first_name": "MARYAM",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "ADMINISTRATOR/LICENSEE",
        "authorized_official_telephone_number": "949-485-1376",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avalon Guest Home I",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Fullerton, CA
• Providers in Fullerton, 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 Oct 20, 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.