Provider Demographics
NPI: | 1285048462 |
---|---|
Name: | CARE CHOICE, LLC |
Entity type: | Organization |
Organization Name: | CARE CHOICE, LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | PRAXEDES SEDY |
Authorized Official - Middle Name: | BERNARDO |
Authorized Official - Last Name: | DEMESA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | NHA |
Authorized Official - Phone: | 209-406-6610 |
Mailing Address - Street 1: | 10740 OAKWILDE AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | STOCKTON |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95212-9249 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 209-406-6610 |
Mailing Address - Fax: | 209-955-0106 |
Practice Address - Street 1: | 5400 STINE RD |
Practice Address - Street 2: | |
Practice Address - City: | BAKERSFIELD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93313-2825 |
Practice Address - Country: | US |
Practice Address - Phone: | 661-398-8802 |
Practice Address - Fax: | 661-837-8940 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-06-16 |
Last Update Date: | 2014-06-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 157206839 | 310400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |