Healthcare Provider Details

I. General information

NPI: 1881745487
Provider Name (Legal Business Name): COORDINATED CARE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6812 OAK AVE
SAN GABRIEL CA
91775-2030
US

IV. Provider business mailing address

6812 OAK AVE
SAN GABRIEL CA
91775-2030
US

V. Phone/Fax

Practice location:
  • Phone: 626-446-5263
  • Fax: 626-446-8109
Mailing address:
  • Phone: 626-446-5263
  • Fax: 626-446-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number9500092
License Number StateCA

VIII. Authorized Official

Name: KEVIN ERWIN CABLAYAN
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 619-521-9641