Provider Demographics
NPI:1043357866
Name:CAREMERIDIAN, LLC
Entity Type:Organization
Organization Name:CAREMERIDIAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:IMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-263-6632
Mailing Address - Street 1:18A JOURNEY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5342
Mailing Address - Country:US
Mailing Address - Phone:949-263-6632
Mailing Address - Fax:949-266-7679
Practice Address - Street 1:1540 TEAL CLUB RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-8639
Practice Address - Country:US
Practice Address - Phone:805-382-1921
Practice Address - Fax:805-382-9721
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL MENTOR HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000384314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050000384OtherSTATE DHS LICENSE#
CAHCB00008FMedicaid