Provider Demographics
NPI:1023393162
Name:UNITED CARE NETWORK, LLC
Entity Type:Organization
Organization Name:UNITED CARE NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUCHAVCHILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-748-1919
Mailing Address - Street 1:3850 PELONA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-5458
Mailing Address - Country:US
Mailing Address - Phone:661-206-9492
Mailing Address - Fax:661-206-9503
Practice Address - Street 1:3850 PELONA VISTA DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-5458
Practice Address - Country:US
Practice Address - Phone:661-206-9492
Practice Address - Fax:661-206-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001741314000000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550001741OtherCALIFORNIA DEPARTMENT OF PUBLIC HEALTH