Provider Demographics
NPI:1215319249
Name:CARESITE HEALTH LLC
Entity type:Organization
Organization Name:CARESITE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-392-6411
Mailing Address - Street 1:28125 BRADLEY RD
Mailing Address - Street 2:SUITE 260B
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2248
Mailing Address - Country:US
Mailing Address - Phone:855-392-6411
Mailing Address - Fax:
Practice Address - Street 1:28125 BRADLEY RD
Practice Address - Street 2:SUITE 260B
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-2248
Practice Address - Country:US
Practice Address - Phone:855-392-6411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X, 332U00000X
CA1578548822261QR0208X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No332U00000XSuppliersHome Delivered Meals