Provider Demographics
NPI:1093195646
Name:ATHENA CARE GROUP, LLC
Entity Type:Organization
Organization Name:ATHENA CARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-230-3463
Mailing Address - Street 1:32999 LAMTARRA LOOP
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7866
Mailing Address - Country:US
Mailing Address - Phone:562-230-3463
Mailing Address - Fax:855-884-4754
Practice Address - Street 1:32999 LAMTARRA LOOP
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7866
Practice Address - Country:US
Practice Address - Phone:562-230-3463
Practice Address - Fax:855-884-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility