Provider Demographics
NPI:1689737991
Name:ULTIMATE CAREGIVERS
Entity Type:Organization
Organization Name:ULTIMATE CAREGIVERS
Other - Org Name:ULTIMATE CAREGIVERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-400-8241
Mailing Address - Street 1:3313 ARTHUR MACARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-6771
Mailing Address - Country:US
Mailing Address - Phone:562-400-8241
Mailing Address - Fax:
Practice Address - Street 1:3313 ARTHUR MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-6771
Practice Address - Country:US
Practice Address - Phone:562-400-8241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service