Healthcare Provider Details

I. General information

NPI: 1730339797
Provider Name (Legal Business Name): EMERICARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 S SAN DIMAS AVE
SAN DIMAS CA
91773-5108
US

IV. Provider business mailing address

1740 S SAN DIMAS AVE
SAN DIMAS CA
91773-5108
US

V. Phone/Fax

Practice location:
  • Phone: 909-394-0304
  • Fax: 909-394-0903
Mailing address:
  • Phone: 909-394-0304
  • Fax: 909-394-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number950000124
License Number StateCA

VIII. Authorized Official

Name: JOANNE K LESKOWICZ
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 414-918-5000