Healthcare Provider Details

I. General information

NPI: 1578249876
Provider Name (Legal Business Name): D12 CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 E ISLAND CT
ELK GROVE CA
95758-7428
US

IV. Provider business mailing address

PO BOX 580040
ELK GROVE CA
95758-0001
US

V. Phone/Fax

Practice location:
  • Phone: 844-663-6203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: LOREN DOCENA
Title or Position: MANAGING MEMBER
Credential:
Phone: 916-955-4943