Organization
PORTSMOUTH SENIOR HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE FIDES LAO (LICENSEE)
(951) 309-1158
Entity
Organization
Contact information
Practice address
28611 PORTSMOUTH DR, MENIFEE, CA 92586-2658
(951) 309-1158
Mailing address
1060 E LURAY ST, LONG BEACH, CA 90807-1020
(951) 309-1158
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
11/05/2025
Last updated
11/05/2025
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