Agate Congregate Living LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

AGATE CONGREGATE LIVING LLC

Practice address

13968 Agate CT
Eastvale, CA 92880-3834

Phone

(949) 233-1645

Fax

(951) 220-7169

NPI assigned

Nov 20, 2024

Last updated

Nov 20, 2024By 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

Mr. Simm K Sanasinh, OWNER

Title

Ceo/Owner

Phone

(949) 233-1645

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1732060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732060800000",
    "number": "1982429247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6835 RIVERGLEN CT",
            "city": "EASTVALE",
            "state": "CA",
            "postal_code": "928803842",
            "telephone_number": "949-233-1645",
            "fax_number": "951-220-7169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13968 AGATE CT",
            "city": "EASTVALE",
            "state": "CA",
            "postal_code": "928803834",
            "telephone_number": "949-233-1645",
            "fax_number": "951-220-7169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGATE CONGREGATE LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-20",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A",
        "authorized_official_last_name": "SANASINH",
        "authorized_official_first_name": "SIMM",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "949-233-1645",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; 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.