Provider Demographics
NPI:1225819360
Name:ST. CLAIR SENIOR CARE LLC
Entity Type:Organization
Organization Name:ST. CLAIR SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY JOY
Authorized Official - Middle Name:CASTRO
Authorized Official - Last Name:LANTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-521-4996
Mailing Address - Street 1:830 SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5704
Mailing Address - Country:US
Mailing Address - Phone:562-521-4996
Mailing Address - Fax:
Practice Address - Street 1:830 SAINT CLAIR ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5704
Practice Address - Country:US
Practice Address - Phone:562-521-4996
Practice Address - Fax:657-235-8725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility