Healthcare Provider Details

I. General information

NPI: 1932417227
Provider Name (Legal Business Name): EMERICARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72201 COUNTRY CLUB DR
RANCHO MIRAGE CA
92270-4001
US

IV. Provider business mailing address

6737 W WASHINGTON ST SUITE 2300
MILWAUKEE WI
53214-5647
US

V. Phone/Fax

Practice location:
  • Phone: 760-340-5999
  • Fax: 760-341-9972
Mailing address:
  • Phone: 414-918-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number250000759
License Number StateCA

VIII. Authorized Official

Name: MARK OHLENDORF
Title or Position: PRESIDENT
Credential:
Phone: 414-918-5000