=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285048462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE CHOICE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2014
-----------------------------------------------------
Last Update Date | 06/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5400 STINE RD
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93313-2825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-398-8802
-----------------------------------------------------
Fax | 661-837-8940
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10740 OAKWILDE AVE
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95212-9249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-406-6610
-----------------------------------------------------
Fax | 209-955-0106
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. PRAXEDES SEDY BERNARDO DEMESA
-----------------------------------------------------
Credential | NHA
-----------------------------------------------------
Telephone | 209-406-6610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 157206839
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------