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General NPI Number Information
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NPI Number | 1780362152
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Entity Type | Organization
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Legal Business Name | CITRUS SENIOR CARE
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 2895 U ST # 7
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-0207
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Country | US
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Telephone | 909-206-4172
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Fax |
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Provider Business Mailing Address
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Address Line | 2895 U ST # 7
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-0207
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Country | US
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Telephone | 909-206-4172
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS COOK
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Credential |
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Telephone | 909-206-4172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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