Everett Forest,LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

366410695 Issued in CA

Legal business name

EVERETT FOREST,LLC

Doing business as

Assisted Living-Rcfe/Hospice

Practice address

11350 Poplar St
Loma Linda, CA 92354-3519

Phone

(909) 799-3170

Fax

(909) 799-1381

NPI assigned

Nov 4, 2016

Organization subpart

No

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

Authorized official

Name

Angelo Swanson Galasinao, ADMINISTRATOR

Title

Licensee and Administrator

Phone

(909) 799-3170

Specialties & licenses 1

Addresses

Other names 1

• ASSISTED LIVING-RCFE/HOSPICE Doing business as

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

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485475200000",
    "number": "1316499536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11350 POPLAR ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543519",
            "telephone_number": "909-799-3170",
            "fax_number": "909-799-1381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11350 POPLAR ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543519",
            "telephone_number": "909-799-3170",
            "fax_number": "909-799-1381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERETT FOREST,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-04",
        "last_updated": "2017-01-27",
        "status": "A",
        "authorized_official_last_name": "GALASINAO",
        "authorized_official_first_name": "ANGELO",
        "authorized_official_middle_name": "SWANSON",
        "authorized_official_title_or_position": "LICENSEE AND ADMINISTRATOR",
        "authorized_official_telephone_number": "909-799-3170",
        "authorized_official_credential": "ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "366410695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ASSISTED LIVING-RCFE/HOSPICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Evan Hyun-Jin Chung MD Inc
• Nicole Evangelista
• Dwight Charles Evans, M.D.
• Erica Jinhee Evans, MD
• Tiare Nicole Evans, M.D.
• Inez June Ezea
• Kelley Ezell, RD
• Ngozi Margarete Ezinwa, MD
• Sharon Fabbri, N.P.
• Armand Cito R Fabella, MSN, FNP-C

• Assisted Living Facility in Loma Linda, CA
• Providers in Loma Linda, 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 Jan 27, 2017; 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.