Provider Demographics
NPI:1043820434
Name:JC COTTAGES LLC
Entity Type:Organization
Organization Name:JC COTTAGES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:PARUNGAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-728-5519
Mailing Address - Street 1:15332 SHASTA LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3027
Mailing Address - Country:US
Mailing Address - Phone:714-728-5519
Mailing Address - Fax:714-622-5118
Practice Address - Street 1:1013 HOLLYDALE DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-2820
Practice Address - Country:US
Practice Address - Phone:714-519-3927
Practice Address - Fax:714-622-5118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility