Provider Demographics
NPI:1437556677
Name:FRONT PORCH COMMUNITIES OPERATING GROUP, LLC
Entity Type:Organization
Organization Name:FRONT PORCH COMMUNITIES OPERATING GROUP, LLC
Other - Org Name:FREDERICKA MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-729-8100
Mailing Address - Street 1:800 N BRAND BLVD FL 19
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1231
Mailing Address - Country:US
Mailing Address - Phone:818-254-4100
Mailing Address - Fax:818-254-4101
Practice Address - Street 1:183 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-1822
Practice Address - Country:US
Practice Address - Phone:619-205-4100
Practice Address - Fax:619-422-2686
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRONT PORCH COMMUNITIES AND SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374603402310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility