Provider Demographics
NPI:1568680940
Name:COMMUNICARE HEALTH CENTERS
Entity Type:Organization
Organization Name:COMMUNICARE HEALTH CENTERS
Other - Org Name:ESPARTO DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL INFO SYSTEMS
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-753-3498
Mailing Address - Street 1:PO BOX 1260
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-1260
Mailing Address - Country:US
Mailing Address - Phone:530-753-3498
Mailing Address - Fax:
Practice Address - Street 1:16827 FREEMONT ST.
Practice Address - Street 2:
Practice Address - City:ESPARTO
Practice Address - State:CA
Practice Address - Zip Code:95627
Practice Address - Country:US
Practice Address - Phone:530-787-4972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70985FMedicaid