Provider Demographics
NPI:1275187700
Name:CARE JORDAN SENIOR HOMES, LLC
Entity Type:Organization
Organization Name:CARE JORDAN SENIOR HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GIDEON
Authorized Official - Middle Name:GINACAY
Authorized Official - Last Name:LIMPIADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-365-4155
Mailing Address - Street 1:8728 CANARY AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6353
Mailing Address - Country:US
Mailing Address - Phone:657-301-2629
Mailing Address - Fax:714-982-3348
Practice Address - Street 1:8728 CANARY AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6353
Practice Address - Country:US
Practice Address - Phone:657-301-2629
Practice Address - Fax:714-982-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA306005439OtherRCFE