Provider Demographics
NPI:1376232116
Name:ARK HOMES CONGREGATE LIVING HEALTH FACILITY
Entity Type:Organization
Organization Name:ARK HOMES CONGREGATE LIVING HEALTH FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATHIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-893-0589
Mailing Address - Street 1:12167 RICHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12167 RICHFIELD DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-8910
Practice Address - Country:US
Practice Address - Phone:626-893-0589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No251J00000XAgenciesNursing Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient