3395493

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

3395493

Doing business as

St Simon Home
St Simon Home II

Practice address

4458 Via del Valle
Yorba Linda, CA 92886-3021

Phone

(714) 900-0694

Fax

(714) 463-4403

NPI assigned

Dec 6, 2018

Last updated

Dec 6, 2018By 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

Dorsey Rose Marchello

Title

Vice President

Phone

(714) 900-0694

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 2

• St Simon Home Doing business as
• St Simon Home II Doing business as

Locations

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

{
    "created_epoch": "1544054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544054400000",
    "number": "1811468564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18340 YORBA LINDA BLVD # 443",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "928864058",
            "telephone_number": "714-900-0694",
            "fax_number": "714-463-4403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4458 VIA DEL VALLE",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "928863021",
            "telephone_number": "714-900-0694",
            "fax_number": "714-463-4403"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4704 Avenida De Las Flores",
            "address_purpose": "LOCATION",
            "city": "Yorba Linda",
            "state": "CA",
            "postal_code": "928862912",
            "country_code": "US",
            "telephone_number": "714-900-0694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "3395493",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-06",
        "last_updated": "2018-12-06",
        "status": "A",
        "authorized_official_last_name": "MARCHELLO",
        "authorized_official_first_name": "DORSEY",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "714-900-0694"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RCFE",
            "identifier": "306004719",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RCFE",
            "identifier": "306004538",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Simon Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Simon Home II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Yorba Linda, CA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2018; 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.