Provider Demographics
NPI:1508570466
Name:CORONADO SENIOR CARE CORP
Entity Type:Organization
Organization Name:CORONADO SENIOR CARE CORP
Other - Org Name:COMFORT KEEPERS 521
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GYORGY
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-435-6318
Mailing Address - Street 1:830 ORANGE AVE STE J2
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2645
Mailing Address - Country:US
Mailing Address - Phone:619-435-6318
Mailing Address - Fax:
Practice Address - Street 1:830 ORANGE AVE STE J2
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-2645
Practice Address - Country:US
Practice Address - Phone:619-435-6318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care