1639476856 NPI number — CARE DIMENSIONS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639476856 NPI number — CARE DIMENSIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE DIMENSIONS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARE DIMENSIONS - SAN DIEGO
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639476856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3401 W SUNFLOWER AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92704-6948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-619-8766
Provider Business Mailing Address Fax Number:
714-439-9603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11440 W BERNARDO CT
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92127-1641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-366-7088
Provider Business Practice Location Address Fax Number:
858-834-4084
Provider Enumeration Date:
02/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PHAN
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-619-8766

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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