Provider Demographics
NPI:1013187517
Name:COCA INC., DBA PERSONAL CARE SERVICES
Entity Type:Organization
Organization Name:COCA INC., DBA PERSONAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLIENT SERVIES
Authorized Official - Prefix:
Authorized Official - First Name:CHARISSE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-399-0888
Mailing Address - Street 1:791 MARYLIND AVE BLDG 1
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3531
Mailing Address - Country:US
Mailing Address - Phone:909-399-0888
Mailing Address - Fax:909-399-3555
Practice Address - Street 1:791 MARYLIND AVE BLDG 1
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3531
Practice Address - Country:US
Practice Address - Phone:909-399-0888
Practice Address - Fax:909-399-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)