Provider Demographics
NPI:1740747096
Name:CAREPROVIDER ORG FOUNDATION
Entity Type:Organization
Organization Name:CAREPROVIDER ORG FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLIBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-967-1105
Mailing Address - Street 1:281 E WORKMAN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3566
Mailing Address - Country:US
Mailing Address - Phone:626-967-1105
Mailing Address - Fax:626-967-1107
Practice Address - Street 1:281 E WORKMAN ST STE 203
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3566
Practice Address - Country:US
Practice Address - Phone:626-967-1105
Practice Address - Fax:626-967-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568913580OtherNPPES
CA1568913887OtherNPPES
CA1942751268OtherNPPES