Provider Demographics
NPI:1750670469
Name:3GENCARE, INC
Entity Type:Organization
Organization Name:3GENCARE, INC
Other - Org Name:SAN MARINO MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-625-2838
Mailing Address - Street 1:4016 GRAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5491
Mailing Address - Country:US
Mailing Address - Phone:310-625-2838
Mailing Address - Fax:323-846-5788
Practice Address - Street 1:6812 OAK AVE
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-2030
Practice Address - Country:US
Practice Address - Phone:626-446-5263
Practice Address - Fax:626-446-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9500000092314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555825Medicare Oscar/Certification