Provider Demographics
NPI:1336403831
Name:ST CARMEN HEALTH PROVIDERS, INC.
Entity type:Organization
Organization Name:ST CARMEN HEALTH PROVIDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSEBELLE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-602-6546
Mailing Address - Street 1:2060 E ROUTE 66
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4691
Mailing Address - Country:US
Mailing Address - Phone:626-335-2167
Mailing Address - Fax:626-387-9991
Practice Address - Street 1:2060 E ROUTE 66
Practice Address - Street 2:SUITE 204
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4691
Practice Address - Country:US
Practice Address - Phone:626-335-2167
Practice Address - Fax:866-583-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based