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General NPI Number Information
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NPI Number | 1619866373
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Entity Type | Organization
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Legal Business Name | IELO CARE LLC
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 12/21/2025
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Provider Practice Location Address
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Address Line | 2345 NEW BRIGHTON LN
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City | STOCKTON
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State | CA
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Zip | 95209-4290
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Country | US
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Telephone | 559-380-6641
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Fax | 209-451-2561
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Provider Business Mailing Address
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Address Line | 2345 NEW BRIGHTON LN
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City | STOCKTON
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State | CA
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Zip | 95209-4290
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Country | US
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Telephone | 559-380-6641
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Fax | 209-451-2561
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. OLIVER BRYAN NGAN
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Credential | REGISTERED NURSE
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Telephone | 559-380-6641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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