Provider Demographics
NPI:1629674957
Name:SUNCREST HEALTHCARE
Entity Type:Organization
Organization Name:SUNCREST HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MABASA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-570-7160
Mailing Address - Street 1:36923 COOK ST
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36923 COOK ST
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6073
Practice Address - Country:US
Practice Address - Phone:213-570-7160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health