MEDICARE: UNITED CARE HOMES, INC. - KINBRAE

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	315P00000X	Intellectual Disabilities Intermediate Care Facility		CA

General Provider Information

NPI Number	:	1841344918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED CARE HOMES, INC. - KINBRAE

Provider Business Mailing Address
First Line	:	1982 CAMWOOD AVE
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-4044
Country	:	US
Telephone Number	:	626-810-5567
Fax Number	:	626-810-4910

Provider Business Practice Location Address
First Line	:	1160 KINBRAE AVE
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-2023
Country	:	US
Telephone Number	:	626-369-2970
Fax Number	:	626-369-2970

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUSANA TUBIANOSA
Credential	:
Telephone Number	:	626-831-2833

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	08/22/2020

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