Provider Demographics
NPI:1275276958
Name:FUENTES CARE HOMES LLC
Entity Type:Organization
Organization Name:FUENTES CARE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:626-260-5635
Mailing Address - Street 1:16689 KEY LIME BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-6926
Mailing Address - Country:US
Mailing Address - Phone:626-260-5635
Mailing Address - Fax:
Practice Address - Street 1:26450 HELENE DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-1876
Practice Address - Country:US
Practice Address - Phone:626-260-5635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility