Provider Demographics
NPI:1780655720
Name:UNITED CARE PROVIDERS-ST FRANCIS
Entity Type:Organization
Organization Name:UNITED CARE PROVIDERS-ST FRANCIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:J
Authorized Official - Last Name:FESTEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-802-6303
Mailing Address - Street 1:18409 DANCY ST
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4755
Mailing Address - Country:US
Mailing Address - Phone:818-802-6303
Mailing Address - Fax:
Practice Address - Street 1:12842 GLENMERE DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5985
Practice Address - Country:US
Practice Address - Phone:951-242-8106
Practice Address - Fax:951-601-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80045FMedicaid