Provider Demographics
NPI:1750980835
Name:AVERY GARDEN SENIOR CARE HOME, INC.
Entity type:Organization
Organization Name:AVERY GARDEN SENIOR CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER- PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-515-9279
Mailing Address - Street 1:7751 STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-5540
Mailing Address - Country:US
Mailing Address - Phone:818-515-9279
Mailing Address - Fax:951-946-9151
Practice Address - Street 1:26600 IRONWOOD AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-1716
Practice Address - Country:US
Practice Address - Phone:818-515-9279
Practice Address - Fax:951-946-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility