Provider Demographics
NPI:1396821971
Name:FRONT PORCH COMMUNITIES AND SERVICES
Entity Type:Organization
Organization Name:FRONT PORCH COMMUNITIES AND SERVICES
Other - Org Name:KINGSLEY MANOR CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR RISK MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-956-7360
Mailing Address - Street 1:1055 N KINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1207
Mailing Address - Country:US
Mailing Address - Phone:323-661-1128
Mailing Address - Fax:323-661-4121
Practice Address - Street 1:1055 N KINGSLEY DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1207
Practice Address - Country:US
Practice Address - Phone:323-661-1128
Practice Address - Fax:323-661-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197602346310400000X
CA970000015314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05086GMedicaid
CARCF00015FMedicaid
CARCF00015FMedicaid