1811174600 NPI number — ST. PHILOMENA CARE HOMES, INC.

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 1811174600 NPI number — ST. PHILOMENA CARE HOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. PHILOMENA CARE HOMES, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1811174600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19628 AVENIDA DEL CAMPO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-468-1012
Provider Business Mailing Address Fax Number:
626-839-1578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19628 AVENIDA DEL CAMPO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-468-1012
Provider Business Practice Location Address Fax Number:
626-839-1578
Provider Enumeration Date:
01/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PASCUAL
Authorized Official First Name:
GERARDO
Authorized Official Middle Name:
OLIVAR
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
626-253-6949

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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