Provider Demographics
NPI:1508167396
Name:CALIFORNIA NURSING CARE SERVICES, INC.
Entity Type:Organization
Organization Name:CALIFORNIA NURSING CARE SERVICES, INC.
Other - Org Name:CNC HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:O
Authorized Official - Last Name:AIYETIWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-989-7700
Mailing Address - Street 1:11010 ARROW RTE
Mailing Address - Street 2:SUITE UNIT 109
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4826
Mailing Address - Country:US
Mailing Address - Phone:909-989-7700
Mailing Address - Fax:877-824-9622
Practice Address - Street 1:11010 ARROW RTE
Practice Address - Street 2:SUITE UNIT 109
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4826
Practice Address - Country:US
Practice Address - Phone:909-989-7700
Practice Address - Fax:877-824-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2012-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001645251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059423Medicare Oscar/Certification