Provider Demographics
NPI:1366021156
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:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GIDEON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMPIADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-365-4155
Mailing Address - Street 1:1615 KENT LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-4732
Mailing Address - Country:US
Mailing Address - Phone:714-982-3348
Mailing Address - Fax:
Practice Address - Street 1:1615 KENT LN
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-4732
Practice Address - Country:US
Practice Address - Phone:714-646-6750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE JORDAN SENIOR HOMES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA306005777OtherCCDSS