Healthcare Provider Details

I. General information

NPI: 1255573473
Provider Name (Legal Business Name): CAREGIVERS ETC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33515 PEMBROOK PL
YUCAIPA CA
92399-3431
US

IV. Provider business mailing address

33515 PEMBROOK PL
YUCAIPA CA
92399-3431
US

V. Phone/Fax

Practice location:
  • Phone: 909-557-7496
  • Fax: 909-790-6503
Mailing address:
  • Phone: 909-557-7496
  • Fax: 909-790-6503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LYNN LOOYSEN
Title or Position: OWNER
Credential: RN
Phone: 909-557-7496