Provider Demographics
NPI:1083373302
Name:LUXURY LIVING SENIOR CARE LLC
Entity Type:Organization
Organization Name:LUXURY LIVING SENIOR CARE LLC
Other - Org Name:CYECREST GUEST HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-600-7083
Mailing Address - Street 1:9049 LEMONGRASS CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5604
Mailing Address - Country:US
Mailing Address - Phone:714-785-9555
Mailing Address - Fax:
Practice Address - Street 1:139 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2235
Practice Address - Country:US
Practice Address - Phone:714-600-7083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility