Provider Demographics
NPI:1235285990
Name:COMMUNITY EDUCATION ASSOCIATES, INC
Entity Type:Organization
Organization Name:COMMUNITY EDUCATION ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-224-4581
Mailing Address - Street 1:PO BOX 90338
Mailing Address - Street 2:CALIFORNIA
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90809-0338
Mailing Address - Country:US
Mailing Address - Phone:909-224-4581
Mailing Address - Fax:
Practice Address - Street 1:1171 MAPLE VIEW DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-4104
Practice Address - Country:US
Practice Address - Phone:909-868-7137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9600001339315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60993FMedicaid