Provider Demographics
NPI:1265259337
Name:UNITED IN CHANGE ASSISTED LIVING AND MEMORY CARE LLC
Entity type:Organization
Organization Name:UNITED IN CHANGE ASSISTED LIVING AND MEMORY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ETTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-498-1770
Mailing Address - Street 1:26452 AVENIDA DE LA PAZ
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4240
Mailing Address - Country:US
Mailing Address - Phone:951-498-1770
Mailing Address - Fax:
Practice Address - Street 1:26452 AVENIDA DE LA PAZ
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4240
Practice Address - Country:US
Practice Address - Phone:951-234-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility