Provider Demographics
NPI:1366643603
Name:MUTUAL CARE MANAGEMENT, INC.
Entity Type:Organization
Organization Name:MUTUAL CARE MANAGEMENT, INC.
Other - Org Name:SAME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:951-688-3636
Mailing Address - Street 1:9025 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-2157
Mailing Address - Country:US
Mailing Address - Phone:951-688-3636
Mailing Address - Fax:951-688-3031
Practice Address - Street 1:9025 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-2157
Practice Address - Country:US
Practice Address - Phone:951-688-3636
Practice Address - Fax:951-688-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000135314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770690034OtherNPI
CALTC06315FMedicaid
CA1770690034OtherNPI