Provider Demographics
NPI:1093864944
Name:DEVELOPMENTAL CLIENT CARE
Entity Type:Organization
Organization Name:DEVELOPMENTAL CLIENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM MD
Authorized Official - Phone:951-243-5129
Mailing Address - Street 1:11751 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-6316
Mailing Address - Country:US
Mailing Address - Phone:951-243-5129
Mailing Address - Fax:951-485-2642
Practice Address - Street 1:24675 BAY AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3810
Practice Address - Country:US
Practice Address - Phone:951-243-5129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000280320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60350GOtherLTC PROVIDER