Provider Demographics
NPI:1831919190
Name:PNP ESTATE LLC
Entity type:Organization
Organization Name:PNP ESTATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-316-6962
Mailing Address - Street 1:12495 LIMONITE AVE STE 1042
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-2457
Mailing Address - Country:US
Mailing Address - Phone:213-316-6962
Mailing Address - Fax:
Practice Address - Street 1:5430 SIERRA VISTA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3114
Practice Address - Country:US
Practice Address - Phone:213-316-6962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility