Healthcare Provider Details

I. General information

NPI: 1093195646
Provider Name (Legal Business Name): ATHENA CARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32999 LAMTARRA LOOP
MENIFEE CA
92584-7866
US

IV. Provider business mailing address

32999 LAMTARRA LOOP
MENIFEE CA
92584-7866
US

V. Phone/Fax

Practice location:
  • Phone: 562-230-3463
  • Fax: 855-884-4754
Mailing address:
  • Phone: 562-230-3463
  • Fax: 855-884-4754

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: MS. SUSANNA FLORES
Title or Position: CO-OWNER
Credential:
Phone: 562-230-3463