Provider Demographics
NPI:1033876081
Name:CITRUS GARDENS LEASING LLC
Entity Type:Organization
Organization Name:CITRUS GARDENS LEASING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, CO-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LI
Authorized Official - Last Name:LANGENDOEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-796-8700
Mailing Address - Street 1:3452 E FOOTHILL BLVD STE 720
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-6031
Mailing Address - Country:US
Mailing Address - Phone:626-796-8700
Mailing Address - Fax:626-568-1416
Practice Address - Street 1:25911 STANFORD ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-4986
Practice Address - Country:US
Practice Address - Phone:951-925-7107
Practice Address - Fax:951-260-3869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility