Provider Demographics
NPI:1023885910
Name:FOOTHILL SERENITY LIVING LLC
Entity type:Organization
Organization Name:FOOTHILL SERENITY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARYDES
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUEVARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-618-0938
Mailing Address - Street 1:235 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-3735
Mailing Address - Country:US
Mailing Address - Phone:213-618-0938
Mailing Address - Fax:213-618-0938
Practice Address - Street 1:8024 REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1640
Practice Address - Country:US
Practice Address - Phone:909-371-3966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home