Provider Demographics
NPI:1376667873
Name:PRIMARY RELIANCE INC
Entity Type:Organization
Organization Name:PRIMARY RELIANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CELESTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-966-1373
Mailing Address - Street 1:226 N STEPHORA AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3152
Mailing Address - Country:US
Mailing Address - Phone:626-966-1373
Mailing Address - Fax:626-915-1155
Practice Address - Street 1:2145 VICTORIA WAY
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2362
Practice Address - Country:US
Practice Address - Phone:626-622-1153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC61037FOtherVICTORIA WAY PROVIDER NO.