Stateside Medical LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

STATESIDE MEDICAL LLC

Practice address

359 W Langston St
Upland, CA 91786-3128

Phone

(714) 408-8996

NPI assigned

Mar 5, 2020

Organization subpart

No

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

Authorized official

Name

Toby MiclatNPI 1376390393

Title

Administrator

Phone

(714) 408-8996

Specialties & licenses 1

Addresses

Tax ID family

Stateside Medical LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Stateside Medical LLC

  • Assisted Living Facility
  • Claremont, CA
  • NPI 1215562913
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Toby Miclat

  • Assisted Living Facility
  • Upland, CA
  • NPI 1376390393
  NPD (past) Authorized official

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

{
    "created_epoch": "1583366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583366400000",
    "number": "1952936312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 N INDIAN HILL BLVD",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917112721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "359 W LANGSTON ST",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863128",
            "telephone_number": "714-408-8996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATESIDE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-05",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A",
        "authorized_official_last_name": "MICLAT",
        "authorized_official_first_name": "TOBY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "714-408-8996"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St Grace Hospice House, Inc (Janet's Enterprise)
• St Grace Manor, Inc
• St. Grace Hospice, Inc.
• Stanley W. Yang, M.D., a Professional Medical Corporation
• Destiny Victoria Starkweather
• Vanessa Steen, M.S., R.D.
• Michael E Stephens, NP
• Steve Chu, D.D.S., Inc.
• Steven Chow MD Inc
• Steven L. Chiu, D.D.S., Inc.

• Assisted Living Facility in Upland, CA
• Providers in Upland, 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 5, 2020; 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.