Healthcare Provider Details

I. General information

NPI: 1154554038
Provider Name (Legal Business Name): CARROLLS COMMUNITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 EMERALD AVE
EL CAJON CA
92020-5005
US

IV. Provider business mailing address

523 EMERALD AVE
EL CAJON CA
92020-5005
US

V. Phone/Fax

Practice location:
  • Phone: 619-442-8893
  • Fax: 619-442-6049
Mailing address:
  • Phone: 619-442-8893
  • Fax: 619-442-6049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number370802857
License Number StateCA

VIII. Authorized Official

Name: MICHELLE NICOL FURTADO
Title or Position: ADMINISTRATOR
Credential:
Phone: 619-442-8893