Provider Demographics
NPI:1952060634
Name:EASTVALE SENIOR HOME CARE, LLC
Entity Type:Organization
Organization Name:EASTVALE SENIOR HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:REA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-303-0130
Mailing Address - Street 1:14318 PINTAIL LOOP
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-0931
Mailing Address - Country:US
Mailing Address - Phone:562-303-0126
Mailing Address - Fax:
Practice Address - Street 1:14318 PINTAIL LOOP
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-0931
Practice Address - Country:US
Practice Address - Phone:562-303-0126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility