ANGEL 1004 RESIDENTIAL HOME
NPI 1609719764
Assisted Living Facility in Fontana, CA

Q: What is Angel 1004 Residential Home's NPI number?

The NPI number for Angel 1004 Residential Home is 1609719764. It was assigned to this organization in the NPPES registry on April 13, 2026.

Q: What is Angel 1004 Residential Home's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Active since April 13, 2026

7142 VERDUGO PL, FONTANA, CA 92336(909) 855-3105 Get Directions Write a Review

NPPES record last updated: April 13, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Angel 1004 Residential Home NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANGEL 1004 RESIDENTIAL HOME (NPI 1609719764) is a healthcare organization registered as an assisted living facility in Fontana, California and active in the NPI registry since April 2026. The organization lists Haejin Kim, Licensee, as its authorized official.

NPPES Registry Identity

NPI1609719764

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameANGEL 1004 RESIDENTIAL HOME

Location Address7142 VERDUGO PLFontana, CA 92336-1452

Mailing Address7142 Verdugo PlFontana, CA 92336-1452 · (909) 855-3105

Phone(909) 855-3105

Organization SubpartNo

Authorized OfficialHaejin KimLicensee · (909) 855-3105

Enumeration DateApril 13, 2026

NPPES CertifiedApril 13, 2026

✔ NPI 1609719764 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

7142 VERDUGO PL, Fontana, CA 92336

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Angel 1004 Residential Home's NPI number?

The NPI number for Angel 1004 Residential Home is 1609719764. It was assigned to this organization in the NPPES registry on April 13, 2026.

Where is Angel 1004 Residential Home located?

Angel 1004 Residential Home is located at 7142 Verdugo Pl, Fontana, CA 92336. The listed phone number is (909) 855-3105.

What is Angel 1004 Residential Home's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

When was this NPI record last updated?

The NPPES record for Angel 1004 Residential Home was last updated on April 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.