Organization
SHASTA RESIDENTIAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN DINO HIEU DINH (CEO)
(714) 300-4540
Entity
Organization
Contact information
Practice address
16274 SHASTA ST, FOUNTAIN VALLEY, CA 92708-1865
(714) 300-4540
Mailing address
16274 SHASTA ST, FOUNTAIN VALLEY, CA 92708-1865
(714) 300-4540
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
03/17/2023
Last updated
03/20/2023
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