Healthcare Provider Details

I. General information

NPI: 1023397007
Provider Name (Legal Business Name): C W BENNETT & ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CENTER DR APT 233
SAN MARCOS CA
92069-3585
US

IV. Provider business mailing address

736 CENTER DR APT 233
SAN MARCOS CA
92069-3585
US

V. Phone/Fax

Practice location:
  • Phone: 760-593-7174
  • Fax: 480-772-4373
Mailing address:
  • Phone: 760-593-7174
  • Fax: 480-772-4373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number553329
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number553329
License Number StateCA

VIII. Authorized Official

Name: WILLIAM E BENNETT
Title or Position: CEO/ADMINISTRATOR
Credential: RN
Phone: 760-593-7174