Provider Demographics
NPI:1982429247
Name:AGATE CONGREGATE LIVING LLC
Entity type:Organization
Organization Name:AGATE CONGREGATE LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SIMM
Authorized Official - Middle Name:K
Authorized Official - Last Name:SANASINH
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:949-233-1645
Mailing Address - Street 1:6835 RIVERGLEN CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3842
Mailing Address - Country:US
Mailing Address - Phone:949-233-1645
Mailing Address - Fax:951-220-7169
Practice Address - Street 1:13968 AGATE CT
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3834
Practice Address - Country:US
Practice Address - Phone:949-233-1645
Practice Address - Fax:951-220-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility