Healthcare Provider Details

I. General information

NPI: 1174736342
Provider Name (Legal Business Name): GENE CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/30/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 PALOMA DR
POMONA CA
91767-5620
US

IV. Provider business mailing address

4657 ELLENITA AVE
TARZANA CA
91356-4931
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-7000
  • Fax: 909-623-7041
Mailing address:
  • Phone: 909-618-6167
  • Fax: 818-881-4983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH GODLEWSKA
Title or Position: PRESIDENT
Credential: M.S.
Phone: 909-623-7000