Provider Demographics
NPI:1508227893
Name:SUPPORTIVE CARE SERVICES FOUNDATION
Entity Type:Organization
Organization Name:SUPPORTIVE CARE SERVICES FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-439-9999
Mailing Address - Street 1:13800 ARIZONA ST # 104
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3951
Mailing Address - Country:US
Mailing Address - Phone:714-439-9999
Mailing Address - Fax:714-242-2002
Practice Address - Street 1:13800 ARIZONA ST # 104
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3951
Practice Address - Country:US
Practice Address - Phone:714-439-9999
Practice Address - Fax:714-242-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care