Cresencia Care Home LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

336427417 Issued in CA

Legal business name

CRESENCIA CARE HOME LLC

Practice address

1785 Honors LN
Corona, CA 92883-0759

Phone

(951) 427-5086

Fax

(951) 547-1369

NPI assigned

Mar 3, 2016

Last updated

Mar 3, 2016By 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

Mr. Restituto Lumba Calilung

Title

Owner/Administrator

Phone

(714) 906-6046

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1456963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456963200000",
    "number": "1639539695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1785 HONORS LN",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928830759",
            "telephone_number": "951-427-5086",
            "fax_number": "951-547-1369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1785 HONORS LN",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928830759",
            "telephone_number": "951-427-5086",
            "fax_number": "951-547-1369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESENCIA CARE HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-03",
        "last_updated": "2016-03-03",
        "status": "A",
        "authorized_official_last_name": "CALILUNG",
        "authorized_official_first_name": "RESTITUTO",
        "authorized_official_middle_name": "LUMBA",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "714-906-6046",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "336427417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Corona, CA
• Providers in Corona, 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 Mar 3, 2016; 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.