Eagle Glen Care Home LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

336426012 Issued in CA

Legal business name

EAGLE GLEN CARE HOME LLC

Practice address

1697 Honors Cir
Corona, CA 92883-0757

Phone

(951) 582-9230

Fax

(951) 340-2740

NPI assigned

Jul 23, 2014

Organization subpart

No

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

Authorized official

Name

Restituto Calilung

Title

Licensee

Phone

(714) 906-6046

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1406073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406073600000",
    "number": "1710395777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1697 HONORS CIR",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928830757",
            "telephone_number": "951-582-9230",
            "fax_number": "951-340-2740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1697 HONORS CIR",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928830757",
            "telephone_number": "951-582-9230",
            "fax_number": "951-340-2740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE GLEN CARE HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-23",
        "last_updated": "2014-07-23",
        "status": "A",
        "authorized_official_last_name": "CALILUNG",
        "authorized_official_first_name": "RESTITUTO",
        "authorized_official_title_or_position": "LICENSEE",
        "authorized_official_telephone_number": "714-906-6046"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "336426012",
            "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 Jul 23, 2014; 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.