Provider Demographics
NPI:1801030457
Name:HOLY INFANT JESUS CARE HOME, INC.
Entity Type:Organization
Organization Name:HOLY INFANT JESUS CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:OLIVAR
Authorized Official - Last Name:PASCUAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-253-6949
Mailing Address - Street 1:18812 HIGHCASTLE ST
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-6140
Mailing Address - Country:US
Mailing Address - Phone:626-253-6949
Mailing Address - Fax:909-594-2700
Practice Address - Street 1:18812 HIGHCASTLE ST
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-6140
Practice Address - Country:US
Practice Address - Phone:626-253-6949
Practice Address - Fax:909-594-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3138462313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility