Autumn Bliss Home LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

AUTUMN BLISS HOME LLC

Practice address

17885 Athol St
Fontana, CA 92335-5127

Phone

(626) 373-7619

NPI assigned

Feb 9, 2024

Organization subpart

No

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

Authorized official

Name

Regine Enriquez

Title

Licensee

Phone

(626) 373-7619

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1707436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707436800000",
    "number": "1669236626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17885 ATHOL ST",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923355127",
            "telephone_number": "626-373-7619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17885 ATHOL ST",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923355127",
            "telephone_number": "626-373-7619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN BLISS HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-09",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A",
        "authorized_official_last_name": "ENRIQUEZ",
        "authorized_official_first_name": "REGINE",
        "authorized_official_title_or_position": "LICENSEE",
        "authorized_official_telephone_number": "626-373-7619"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Fontana, CA
• Providers in Fontana, 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 Feb 9, 2024; 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.