Healthcare Provider Details

I. General information

NPI: 1932294055
Provider Name (Legal Business Name): MERIDIAN HEALTHCARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 LINCOLN AVENUE UNITS 1,2,3
CYPRESS CA
90630-6110
US

IV. Provider business mailing address

4470 LINCOLN AVENUE UNITS 1,2,3
CYPRESS CA
90630-6110
US

V. Phone/Fax

Practice location:
  • Phone: 714-826-9664
  • Fax: 714-826-9614
Mailing address:
  • Phone: 714-826-9664
  • Fax: 714-826-9614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: NATIVIDAD L RILLORTA
Title or Position: CFO
Credential:
Phone: 714-826-9664