Organization
ANGEL 1004 RESIDENTIAL HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAEJIN KIM (LICENSEE)
(909) 855-3105
Entity
Organization
Contact information
Practice address
7142 VERDUGO PL, FONTANA, CA 92336-1452
(909) 855-3105
Mailing address
7142 VERDUGO PL, FONTANA, CA 92336-1452
(909) 855-3105
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
04/13/2026
Last updated
04/13/2026
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