Organization · NPI-2

A Faithful Home LLC

Assisted Living Facility · Mission Viejo, CA

NPI number1528419207
StatusActive
Last updated in NPPESJun 24, 2016

Details

NPI
1528419207
Entity type
Organization (NPI-2)
Legal business name
A Faithful Home LLC
Organization subpart
No
Enumeration date
Jun 24, 2016
Last updated
Jun 24, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
310400000X Assisted Living Facility306004810CAYes

Practice location

26642 Salamanca Dr
Mission Viejo, CA 92691-4923

Phone 949-382-2818 · Fax 949-382-2818

Mailing address

26642 Salamanca Dr
Mission Viejo, CA 92691-4923

Phone 949-382-2818 · Fax 949-382-2818

Authorized official

Theresa Serapio Kholoma
Administrator/Licensee
7143008055

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