Provider Demographics
NPI:1346711504
Name:CEDACAL, LLC.
Entity Type:Organization
Organization Name:CEDACAL, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/RN
Authorized Official - Prefix:
Authorized Official - First Name:ROWIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUCAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-373-6211
Mailing Address - Street 1:5663 CEDARGLEN DR
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-5007
Mailing Address - Country:US
Mailing Address - Phone:626-373-6211
Mailing Address - Fax:
Practice Address - Street 1:5663 CEDARGLEN DR
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-5007
Practice Address - Country:US
Practice Address - Phone:626-373-6211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness