Provider Demographics
NPI:1790915023
Name:CONSUMER'S CHOICE HOME, LLC.
Entity Type:Organization
Organization Name:CONSUMER'S CHOICE HOME, LLC.
Other - Org Name:LOVE & CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZENAIDA
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:DY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-899-5773
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-0086
Mailing Address - Country:US
Mailing Address - Phone:909-899-5773
Mailing Address - Fax:
Practice Address - Street 1:13100 RIESLING DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-9406
Practice Address - Country:US
Practice Address - Phone:909-899-5773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366411418261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities