Healthcare Provider Details

I. General information

NPI: 1205493566
Provider Name (Legal Business Name): CAROLINE ARMSTRONG LVN, ADMINISTRATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 HARTZELL AVE
REDLANDS CA
92374-2523
US

IV. Provider business mailing address

PO BOX 539
MENTONE CA
92359-0539
US

V. Phone/Fax

Practice location:
  • Phone: 909-792-3835
  • Fax:
Mailing address:
  • Phone: 909-806-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number361880724
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number361880724
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number271315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: