Healthcare Provider Details

I. General information

NPI: 1265601991
Provider Name (Legal Business Name): CAREMERIDIAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20621 MAYALL ST
CHATSWORTH CA
91311-3110
US

IV. Provider business mailing address

18-A JOURNEY SUITE 200
ALISA VIEJO CA
92656-5342
US

V. Phone/Fax

Practice location:
  • Phone: 818-886-7928
  • Fax:
Mailing address:
  • Phone: 949-263-6632
  • Fax: 949-261-0457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number550000665
License Number StateCA

VIII. Authorized Official

Name: MRS. CRYSTAL DAWN IMMERMAN
Title or Position: MANAGER OF ADMINISTRATION
Credential:
Phone: 949-263-6632