Fern Home 1 LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

331800142 Issued in CA

Legal business name

FERN HOME 1 LLC

Practice address

3875 Megginson LN
Riverside, CA 92503-3425

Phone

(310) 997-8204

NPI assigned

Aug 16, 2017

Organization subpart

No

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

Authorized official

Name

Joi Mae Gubalane, RCFE ADMINISTRATOR

Title

Licensee/Administrator

Phone

(310) 997-8204

Specialties & licenses 1

Addresses

Other names 1

• FERN HOME 1 Other name

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

{
    "created_epoch": "1502841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1972029486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3875 MEGGINSON LANE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92503",
            "telephone_number": "310-997-8204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3875 MEGGINSON LN",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033425",
            "telephone_number": "310-997-8204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FERN HOME 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-16",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GUBALANE",
        "authorized_official_first_name": "JOI MAE",
        "authorized_official_title_or_position": "LICENSEE/ADMINISTRATOR",
        "authorized_official_telephone_number": "310-997-8204",
        "authorized_official_credential": "RCFE ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "331800142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FERN HOME 1",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Cherie Ferguson
• Jordan Ferguson
• Madelyn Ferguson
• Sharlayne Marie Ferguson
• Jacqueline Ferland
• Christopher Tony Fernandes, DO
• Maria Helena Fernandez de Fiore, NP
• Jose L. Fernandez Jr., MD
• Emily Fernandez-Bell, FNP-C
• April Marie Fernandez, LCSW

• Assisted Living Facility in Riverside, CA
• Providers in Riverside, 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 21, 2022; 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.