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General NPI Number Information
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NPI Number | 1881745487
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Entity Type | Organization
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Legal Business Name | COORDINATED CARE CENTER INC.
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6812 OAK AVE
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City | SAN GABRIEL
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State | CA
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Zip | 91775-2030
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Country | US
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Telephone | 626-446-5263
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Fax | 626-446-8109
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Provider Business Mailing Address
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Address Line | 6812 OAK AVE
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City | SAN GABRIEL
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State | CA
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Zip | 91775-2030
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Country | US
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Telephone | 626-446-5263
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Fax | 626-446-8109
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | KEVIN ERWIN CABLAYAN
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Credential |
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Telephone | 619-521-9641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 9500092
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License Number State | CA
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