=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720263114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUNTINGTON CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2008
-----------------------------------------------------
Last Update Date | 04/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1406 BLUE OAKS BLVD
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95747-5199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-596-1820
-----------------------------------------------------
Fax | 310-220-3121
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3452 E FOOTHILL BLVD STE 130C
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91107-3142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-405-6990
-----------------------------------------------------
Fax | 877-405-6991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | MARK SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-596-1820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------