Provider Demographics
NPI:1902666522
Name:THE HILLS OF SOUTH CREEK I
Entity Type:Organization
Organization Name:THE HILLS OF SOUTH CREEK I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-450-2882
Mailing Address - Street 1:22800 SAVI RANCH PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-4623
Mailing Address - Country:US
Mailing Address - Phone:714-363-3752
Mailing Address - Fax:714-783-3036
Practice Address - Street 1:39869 S CREEK CIR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2818
Practice Address - Country:US
Practice Address - Phone:951-506-5554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility