Provider Demographics
NPI:1528444965
Name:STATCARE RECRUITING
Entity type:Organization
Organization Name:STATCARE RECRUITING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:855-424-4473
Mailing Address - Street 1:139 LUCCA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-7100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:139 LUCCA DR
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-7100
Practice Address - Country:US
Practice Address - Phone:855-424-4473
Practice Address - Fax:855-793-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108325251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care