Provider Demographics
NPI:1821827742
Name:LOVING LEGENDS LLC
Entity type:Organization
Organization Name:LOVING LEGENDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAVONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:DHA
Authorized Official - Phone:951-545-7203
Mailing Address - Street 1:750 S LINCOLN AVE STE 464
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3551
Mailing Address - Country:US
Mailing Address - Phone:951-545-7203
Mailing Address - Fax:
Practice Address - Street 1:408 E MISSION PL
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-2829
Practice Address - Country:US
Practice Address - Phone:951-545-7203
Practice Address - Fax:626-227-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility