Provider Demographics
NPI:1417102039
Name:DEPENDABLE NURSING LLC
Entity Type:Organization
Organization Name:DEPENDABLE NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:ZAN
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-602-0583
Mailing Address - Street 1:5055 AVENIDA ENCINAS
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4375
Mailing Address - Country:US
Mailing Address - Phone:760-602-0583
Mailing Address - Fax:760-602-0584
Practice Address - Street 1:5055 AVENIDA ENCINAS
Practice Address - Street 2:SUITE 120
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-4375
Practice Address - Country:US
Practice Address - Phone:760-602-0583
Practice Address - Fax:760-602-0584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000794251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4864839Medicaid
CAPQ0888OtherSAN DIEGO REGIONAL CENTER VENDOR
CA080000794OtherSTATE OF CALIFORNIA DEPARTMENT OF HEALTH SERVICES HOME HEALTH AGENCY
CA080000794OtherSTATE OF CALIFORNIA DEPARTMENT OF HEALTH SERVICES HOME HEALTH AGENCY