Provider Demographics
NPI:1881217974
Name:AT AWE LLC
Entity Type:Organization
Organization Name:AT AWE LLC
Other - Org Name:AT AWE CONGREGATE LIVING HEALTH FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-590-3403
Mailing Address - Street 1:10876 MORNING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-4202
Mailing Address - Country:US
Mailing Address - Phone:951-214-2234
Mailing Address - Fax:951-214-2102
Practice Address - Street 1:10876 MORNING RIDGE DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-4202
Practice Address - Country:US
Practice Address - Phone:951-214-2234
Practice Address - Fax:951-214-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility