Provider Demographics
NPI:1760057780
Name:FAMILY FIRST CONGREGATED LIVING FACILITY INC
Entity Type:Organization
Organization Name:FAMILY FIRST CONGREGATED LIVING FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-940-9011
Mailing Address - Street 1:13089 PEYTON DR # C316
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6018
Mailing Address - Country:US
Mailing Address - Phone:951-940-9011
Mailing Address - Fax:
Practice Address - Street 1:329 YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-8674
Practice Address - Country:US
Practice Address - Phone:951-940-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care