Provider Demographics
NPI:1457140774
Name:A PLACE LIKE HOME 1 LLC
Entity type:Organization
Organization Name:A PLACE LIKE HOME 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:MARIA JASMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-609-2303
Mailing Address - Street 1:10291 JULIANA LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-2912
Mailing Address - Country:US
Mailing Address - Phone:714-609-2303
Mailing Address - Fax:
Practice Address - Street 1:10291 JULIANA LN
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-2912
Practice Address - Country:US
Practice Address - Phone:714-609-2303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility