Healthcare Provider Details

I. General information

NPI: 1215319249
Provider Name (Legal Business Name): CARESITE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28125 BRADLEY RD SUITE 260B
MENIFEE CA
92586-2248
US

IV. Provider business mailing address

28125 BRADLEY RD SUITE 260B
MENIFEE CA
92586-2248
US

V. Phone/Fax

Practice location:
  • Phone: 855-392-6411
  • Fax:
Mailing address:
  • Phone: 855-392-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number1578548822
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number1578548822
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY GUSTAFSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 855-392-6411