Habilitative Homes Residential Care Facility

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

374603669 Issued in CA

Legal business name

HABILITATIVE HOMES RESIDENTIAL CARE FACILITY

Practice address

11775 Walnut Rd
Lakeside, CA 92040-5624

Phone

(619) 270-4484

NPI assigned

Oct 28, 2015

Last updated

Mar 16, 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

David Clarence Larson

Title

Licenee/Owner/Administrator

Phone

(619) 456-3742

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1445990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458086400000",
    "number": "1891167912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11775 WALNUT ROAD",
            "city": "LAKESIDE",
            "state": "CA",
            "postal_code": "92040",
            "telephone_number": "619-270-4484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11775 WALNUT RD",
            "city": "LAKESIDE",
            "state": "CA",
            "postal_code": "920405624",
            "telephone_number": "619-270-4484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HABILITATIVE HOMES RESIDENTIAL CARE FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-28",
        "last_updated": "2016-03-16",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "CLARENCE",
        "authorized_official_title_or_position": "LICENEE/OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "619-456-3742"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "374603669",
            "primary": true
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "CA",
            "license": "374603669",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "CA",
            "license": "374603669",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CA",
            "license": "374603669",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grant and Pham Dental Corporation
• Ray Gros
• Raewyn Guerrero
• John-Paul M Guillot, DPM
• Joshua Gunpat
• Arkan Hanna I
• Lidia Hanna
• Thomas Hathorn
• Kenny Hoang
• Christine Corado Holman, NURSE PRACTITIONER

• Assisted Living Facility in Lakeside, CA
• Providers in Lakeside, 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 16, 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.