Congregate San Jacinto

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CONGREGATE SAN JACINTO

Practice address

699 Winners Cir
San Jacinto, CA 92582-2741

Phone

(951) 654-2097

NPI assigned

Jul 27, 2015

Organization subpart

No

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

Authorized official

Name

Harry Kistorian

Title

President

Phone

(951) 654-2097

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1437955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437955200000",
    "number": "1437534856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "699 WINNERS CIR",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925822741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "699 WINNERS CIR",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925822741",
            "telephone_number": "951-654-2097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONGREGATE SAN JACINTO",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-27",
        "last_updated": "2015-07-27",
        "status": "A",
        "authorized_official_last_name": "KISTORIAN",
        "authorized_official_first_name": "HARRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-654-2097"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2015; 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.