Provider Demographics
NPI:1639676661
Name:NEW ERA CONGREGATE LIVING FACILITY LLC
Entity Type:Organization
Organization Name:NEW ERA CONGREGATE LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AKUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-236-1095
Mailing Address - Street 1:1180 SEA LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-8469
Mailing Address - Country:US
Mailing Address - Phone:951-236-1095
Mailing Address - Fax:951-689-6856
Practice Address - Street 1:1180 SEA LAVENDER LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-8469
Practice Address - Country:US
Practice Address - Phone:951-236-1095
Practice Address - Fax:951-689-6856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245024314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility