Provider Demographics
NPI:1568701282
Name:SELECT COMPCARE
Entity Type:Organization
Organization Name:SELECT COMPCARE
Other - Org Name:HABITAT SOLUTIONS USA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-890-3699
Mailing Address - Street 1:225 W HOSPITALITY LN
Mailing Address - Street 2:STUITE 200
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3256
Mailing Address - Country:US
Mailing Address - Phone:909-890-3699
Mailing Address - Fax:909-890-4395
Practice Address - Street 1:225 W HOSPITALITY LN
Practice Address - Street 2:STUITE 200
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3256
Practice Address - Country:US
Practice Address - Phone:909-890-3699
Practice Address - Fax:909-890-4395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HABITAT SOLUTIONS USA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8134204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty