Provider Demographics
NPI:1689714214
Name:C.L.O., INC.
Entity Type:Organization
Organization Name:C.L.O., INC.
Other - Org Name:VIA LARGA PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-458-1881
Mailing Address - Street 1:24761 VIA LARGA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1933
Mailing Address - Country:US
Mailing Address - Phone:949-458-1881
Mailing Address - Fax:949-581-4959
Practice Address - Street 1:24761 VIA LARGA
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1933
Practice Address - Country:US
Practice Address - Phone:949-458-1881
Practice Address - Fax:949-581-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X, 315P00000X, 315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80101FMedicaid
CALTC80102FMedicaid
CALTC80112FMedicaid