Provider Demographics
NPI:1952039240
Name:MY NEW HOME CORP.
Entity Type:Organization
Organization Name:MY NEW HOME CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIEP
Authorized Official - Middle Name:
Authorized Official - Last Name:MALMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-272-5286
Mailing Address - Street 1:5289 LODI ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-1152
Mailing Address - Country:US
Mailing Address - Phone:858-272-5286
Mailing Address - Fax:858-272-2571
Practice Address - Street 1:5289 LODI ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-1152
Practice Address - Country:US
Practice Address - Phone:858-272-5286
Practice Address - Fax:858-272-2571
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY NEW HOME CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA374604584OtherFACILITY LICENSE