Provider Demographics
NPI:1336573682
Name:TELECARE CWIC MB
Entity type:Organization
Organization Name:TELECARE CWIC MB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HAISTON
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:760-409-8571
Mailing Address - Street 1:PO BOX 291
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-0291
Mailing Address - Country:US
Mailing Address - Phone:760-409-8571
Mailing Address - Fax:
Practice Address - Street 1:55475 SANTA FE TRL
Practice Address - Street 2:SUITE 100
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3117
Practice Address - Country:US
Practice Address - Phone:855-365-6558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN135730251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care