Healthcare Provider Details

I. General information

NPI: 1265079164
Provider Name (Legal Business Name): ALLSTAR MEDICAL RESPITE AND RECUPERATIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SPERRY DR
COLTON CA
92324-3118
US

IV. Provider business mailing address

10722 ARROW RTE STE 218
RANCHO CUCAMONGA CA
91730-4810
US

V. Phone/Fax

Practice location:
  • Phone: 909-688-8111
  • Fax:
Mailing address:
  • Phone: 909-945-9899
  • Fax: 909-945-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIA CATHERINE KOH CHUA
Title or Position: ADMINISTRATOR
Credential:
Phone: 909-945-9899