Provider Demographics
NPI:1184826679
Name:CAREMERIDIAN, LLC
Entity Type:Organization
Organization Name:CAREMERIDIAN, LLC
Other - Org Name:NEURORESTORATIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-688-5251
Mailing Address - Street 1:163 TECHNOLOGY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2486
Mailing Address - Country:US
Mailing Address - Phone:949-794-0787
Mailing Address - Fax:949-261-0457
Practice Address - Street 1:19856 MAYALL ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3521
Practice Address - Country:US
Practice Address - Phone:818-349-8960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL MENTOR HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-05
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000441C.L.H.F.314000000X
CA980000441314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHCB00016FMedicaid