Provider Demographics
NPI:1104902725
Name:FRONT PORCH COMMUNITIES AND SERVICES
Entity type:Organization
Organization Name:FRONT PORCH COMMUNITIES AND SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR RISK MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-956-7360
Mailing Address - Street 1:842 E VILLA ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1259
Mailing Address - Country:US
Mailing Address - Phone:626-796-8162
Mailing Address - Fax:616-568-9606
Practice Address - Street 1:842 E VILLA ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1259
Practice Address - Country:US
Practice Address - Phone:626-796-8162
Practice Address - Fax:626-568-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950000069314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55429HMedicaid
CA555429Medicare ID - Type Unspecified