# COBBLE CREEK CONGREGATE LIVING LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cobble Creek Congregate Living
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639992266
- **Authorized official:** MARC TANG ADMINISTRATOR (CEO)
- **Authorized official phone:** (949) 235-6269

## Contact information

- **Practice address:** 7462 COBBLE CREEK DR, EASTVALE, CA 92880-3183
- **Practice address phone:** (949) 922-7713
- **Mailing address:** 12672 LIMONITE AVE STE 3E-123, EASTVALE, CA 92880-4201
- **Mailing address phone:** (949) 922-7713

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/04/2024
- **Last updated:** 11/04/2024