MEDICARE: CAREMERIDIAN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	980000693	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	980000693	OTHER	CA	STATE DHS LICENSE#
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770620569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREMERIDIAN, LLC

Provider Business Mailing Address
First Line	:	163 TECHNOLOGY DR STE 200
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-2486
Country	:	US
Telephone Number	:	949-263-6632
Fax Number	:	949-266-8679

Provider Business Practice Location Address
First Line	:	102 E AVOCADO CREST RD
Second Line	:
City	:	LA HABRA HEIGHTS
State	:	CA
Zip	:	90631-8122
Country	:	US
Telephone Number	:	562-691-2486
Fax Number	:	562-691-9505

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MR. SEAN SHEA
Credential	:
Telephone Number	:	949-794-0787

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/18/2019

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