Provider Demographics
NPI:1205686755
Name:COTTAGE CARE HOMES, LLC
Entity type:Organization
Organization Name:COTTAGE CARE HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRKINBINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-423-5220
Mailing Address - Street 1:4221 SHOALCREEK DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-0724
Mailing Address - Country:US
Mailing Address - Phone:949-423-5220
Mailing Address - Fax:
Practice Address - Street 1:4089 INVERNESS DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-0775
Practice Address - Country:US
Practice Address - Phone:949-423-5220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility