Healthcare Provider Details

I. General information

NPI: 1922095215
Provider Name (Legal Business Name): COORDINATED CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
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 Number
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL W. ELBERT
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-446-5263