Provider Demographics
NPI:1609865583
Name:CAREHOUSE HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:CAREHOUSE HEALTHCARE CENTER, LLC
Other - Org Name:CAREHOUSE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:1800 OLD TUSTIN AVE.
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7810
Mailing Address - Country:US
Mailing Address - Phone:714-835-4900
Mailing Address - Fax:714-542-3325
Practice Address - Street 1:1800 OLD TUSTIN AVE.
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-7810
Practice Address - Country:US
Practice Address - Phone:714-835-4900
Practice Address - Fax:714-542-3325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-13
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000645314000000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55765GMedicaid
CALTC55765GMedicaid