Provider Demographics
NPI:1780425744
Name:ABLEWAY ADULT RESIDENTIAL FACILITY LLC
Entity type:Organization
Organization Name:ABLEWAY ADULT RESIDENTIAL FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-233-5881
Mailing Address - Street 1:9826 CEDAR ST APT 12A
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6967
Mailing Address - Country:US
Mailing Address - Phone:424-233-5881
Mailing Address - Fax:
Practice Address - Street 1:17929 STEVENS ST
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-2288
Practice Address - Country:US
Practice Address - Phone:424-233-5881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health