Organization
LA FUENTE LAVENDER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SOTERO CHANDLER RAMAS III (PRESIDENT/CEO)
(909) 346-0292
Entity
Organization
Contact information
Practice address
9545 TAMARIND AVE, FONTANA, CA 92335-5962
(909) 346-0292
(909) 346-0292
Mailing address
9545 TAMARIND AVE, FONTANA, CA 92335-5962
(909) 346-0292
(909) 346-0292
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
361800009
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
361800009
RESIDENTIAL CARE FOR ELDERLY LICENSE NUMBER
CA
Enumeration date
08/09/2016
Last updated
08/09/2016
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