Provider Demographics
NPI:1851797369
Name:RED CARNATION HOMES, LLC
Entity Type:Organization
Organization Name:RED CARNATION HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LLM
Authorized Official - Phone:909-475-8800
Mailing Address - Street 1:PO BOX 23089
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92406-0489
Mailing Address - Country:US
Mailing Address - Phone:909-475-8800
Mailing Address - Fax:909-475-9500
Practice Address - Street 1:6997 PERRIS HILL RD
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-6231
Practice Address - Country:US
Practice Address - Phone:909-475-8800
Practice Address - Fax:909-475-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366425533310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility