=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376835728
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMILLE CAREGIVERS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2011
-----------------------------------------------------
Last Update Date | 05/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1302 BARNETT ROAD
-----------------------------------------------------
City | RAMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-789-9619
-----------------------------------------------------
Fax | 760-789-9619
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1302 BARNETT ROAD
-----------------------------------------------------
City | RAMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-789-9619
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DEBRA M MALDAN
-----------------------------------------------------
Credential | CNA/CHHA
-----------------------------------------------------
Telephone | 760-789-9619
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 3224425
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------