Provider Demographics
NPI:1477885036
Name:C & R GUEST HOMES, INC
Entity Type:Organization
Organization Name:C & R GUEST HOMES, INC
Other - Org Name:CRESCENT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSEE/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALINDA
Authorized Official - Middle Name:CLEMENTE
Authorized Official - Last Name:ULIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-496-9990
Mailing Address - Street 1:7694 HEATHER CIR.
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-1924
Mailing Address - Country:US
Mailing Address - Phone:714-496-9990
Mailing Address - Fax:714-739-4371
Practice Address - Street 1:7694 HEATHER CIR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-1924
Practice Address - Country:US
Practice Address - Phone:714-496-9990
Practice Address - Fax:714-739-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05GP1904OtherMEDICAL PROVIDER NUMBER