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STATESIDE MEDICAL LLC
NPI 1952936312
Assisted Living Facility in Upland, CA

Active since March 05, 2020
359 W LANGSTON ST, UPLAND, CA 91786(714) 408-8996 Get Directions Write a Review

NPPES record last updated: March 5, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Table of Contents

  1. NPI Profile Information
  2. Primary Taxonomy
  3. Authorized Official
  4. Frequently Asked Questions
  • Organization
  • Assisted Living Facility

About STATESIDE MEDICAL LLC

This page provides the complete NPI Profile along with additional information for Stateside Medical Llc, a provider established in Upland, California operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1952936312 assigned on March 2020. The practitioner's primary taxonomy code is 310400000X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The authorized official of this NPI record is Toby Miclat (Administrator)

NPI
1952936312 Verify this NPI
Provider Name
STATESIDE MEDICAL LLC
Entity Type
Organization
Location Address
359 W LANGSTON ST UPLAND, CA 91786
Location Phone
(714) 408-8996
Mailing Address
1920 N INDIAN HILL BLVD CLAREMONT, CA 91711
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
03-05-2020
Last Update Date
03-05-2020
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Assisted Living Facility

Taxonomy Code
310400000X
Type
Nursing & Custodial Care Facilities
Taxonomy Description
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.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

TOBY MICLAT

Authorized Official Title
ADMINISTRATOR
Authorized Official Phone
(714) 408-8996

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Frequently Asked Questions

What is STATESIDE MEDICAL LLC's NPI number?

The NPI number assigned to this healthcare provider is 1952936312, enumerated as an "organization" on March 05, 2020.

Where is the provider located?

The provider is located at 359 W LANGSTON ST UPLAND, CA 91786 and the phone number is (714) 408-8996.

What is the provider's specialty?

Assisted Living Facility with taxonomy code 310400000X.