Healthcare Provider Details

I. General information

NPI: 1619866373
Provider Name (Legal Business Name): IELO CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 NEW BRIGHTON LN
STOCKTON CA
95209-4290
US

IV. Provider business mailing address

2345 NEW BRIGHTON LN
STOCKTON CA
95209-4290
US

V. Phone/Fax

Practice location:
  • Phone: 559-380-6641
  • Fax: 209-451-2561
Mailing address:
  • Phone: 559-380-6641
  • Fax: 209-451-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. OLIVER BRYAN NGAN
Title or Position: PRESIDENT
Credential: REGISTERED NURSE
Phone: 559-380-6641