Healthcare Provider Details

I. General information

NPI: 1912950932
Provider Name (Legal Business Name): JOHNRE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 E JOHNSTON AVE
HEMET CA
92543-7113
US

IV. Provider business mailing address

16162 PONDEROSA LN
RIVERSIDE CA
92504-6155
US

V. Phone/Fax

Practice location:
  • Phone: 951-658-6374
  • Fax: 951-658-5263
Mailing address:
  • Phone: 951-780-5348
  • Fax: 951-780-5348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHNNY SICAT
Title or Position: PRESIDENT
Credential:
Phone: 951-313-5685