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General NPI Number Information
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NPI Number | 1184499717
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Entity Type | Organization
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Legal Business Name | CARE REPUBLIC CCA LLC
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 11175 AZUSA CT STE 110
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4933
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Country | US
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Telephone | 909-317-8207
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Fax |
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Provider Business Mailing Address
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Address Line | 11175 AZUSA CT STE 110
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4933
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Country | US
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Telephone | 909-317-8207
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEMALYNE PINO BUNO
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Credential |
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Telephone | 909-317-8207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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