Healthcare Provider Details

I. General information

NPI: 1477349249
Provider Name (Legal Business Name): CARE SERVICE WORKFORCE APPRENTICESHIP PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 IMPERIAL AVE
SAN DIEGO CA
92114-4213
US

IV. Provider business mailing address

5505 STEVENS WAY # 742351
SAN DIEGO CA
92114-3970
US

V. Phone/Fax

Practice location:
  • Phone: 619-303-6890
  • Fax:
Mailing address:
  • Phone: 619-303-6890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: MS. WANDA L ROGERS
Title or Position: FOUNDER
Credential:
Phone: 619-303-6890