Provider Demographics
NPI:1124207113
Name:CDK HOME CARE INC
Entity Type:Organization
Organization Name:CDK HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPO VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONATO JUAN
Authorized Official - Middle Name:AGUETE
Authorized Official - Last Name:ROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-634-4696
Mailing Address - Street 1:5050 PALO VERDE ST
Mailing Address - Street 2:STE 214
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91768-2829
Mailing Address - Country:US
Mailing Address - Phone:909-482-1232
Mailing Address - Fax:909-482-1237
Practice Address - Street 1:5050 PALO VERDE ST
Practice Address - Street 2:STE 214
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91768-2829
Practice Address - Country:US
Practice Address - Phone:909-482-1232
Practice Address - Fax:909-482-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25IE00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health