Healthcare Provider Details

I. General information

NPI: 1437296217
Provider Name (Legal Business Name): CAREMERIDIAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 BERNARDO AVE
ESCONDIDO CA
92029-6610
US

IV. Provider business mailing address

18A JOURNEY SUITE 200
ALISO VIEJO CA
92656-5342
US

V. Phone/Fax

Practice location:
  • Phone: 760-739-8255
  • Fax: 760-739-8214
Mailing address:
  • Phone: 949-263-6632
  • Fax: 949-266-8679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number080000357
License Number StateCA

VIII. Authorized Official

Name: MRS. CRYSTAL DAWN IMMERMAN
Title or Position: MANAGER OF ADMINISTRATION
Credential:
Phone: 949-263-6632