Healthcare Provider Details

I. General information

NPI: 1326685488
Provider Name (Legal Business Name): ALLSTAR MEDICAL RESPITE AND RECUPERATIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N SPERRY DRIVE
COLTON CA
92324
US

IV. Provider business mailing address

9521 BUSINESS CENTER DR STE 9-101
RANCHO CUCAMONGA CA
91730-7704
US

V. Phone/Fax

Practice location:
  • Phone: 909-945-9899
  • Fax:
Mailing address:
  • Phone: 909-904-7003
  • Fax:

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: MARIA CATHERINE KOH CHUA
Title or Position: CFO/ADMINISTRATOR DESIGNEE
Credential:
Phone: 909-945-9899