OrganizationActive
Angel 1004 Residential Home
NPI 1609719764 · Assisted Living Facility · Fontana, CA
Angel 1004 Residential Home is a Assisted Living Facility organization in Fontana, CA (NPI 1609719764).
Provider details
- NPI number
- 1609719764
- Entity type
- Organization
- Primary specialty
- Assisted Living FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Haejin Kim, Licensee(909) 855-3105
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Established profile(53/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
7142 Verdugo Pl
Fontana, CA 92336-1452
Phone: (909) 855-3105
Street-level locationGet directions
Mailing address
7142 Verdugo Pl
Fontana, CA 92336-1452
Registry dates
- Enumerated
- 2026-04-13
- Last updated
- 2026-04-13
- Certified
- 2026-04-13
Frequently asked questions
- What is Angel 1004 Residential Home's NPI number?
- Angel 1004 Residential Home's National Provider Identifier (NPI) is 1609719764, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Angel 1004 Residential Home?
- Angel 1004 Residential Home is classified in the NPPES registry as Assisted Living Facility (Nursing & Custodial Care Facilities).
- Where is Angel 1004 Residential Home located?
- Angel 1004 Residential Home's practice location on file with NPPES is 7142 Verdugo Pl, Fontana, CA 92336-1452.
- What is Angel 1004 Residential Home's phone number?
- The practice phone number listed in the NPPES registry for Angel 1004 Residential Home is (909) 855-3105.
- Who is the authorized official for Angel 1004 Residential Home?
- The authorized official listed on Angel 1004 Residential Home's NPPES record is Haejin Kim, Licensee. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Angel 1004 Residential Home's NPI active?
- Yes — Angel 1004 Residential Home's NPI (1609719764) is active in the NPPES registry as of the last update on 2026-04-13.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.