Provider Demographics
NPI:1801367479
Name:CARE JULIET LLC
Entity Type:Organization
Organization Name:CARE JULIET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-914-1153
Mailing Address - Street 1:4931 CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3004
Mailing Address - Country:US
Mailing Address - Phone:657-258-9152
Mailing Address - Fax:714-982-3433
Practice Address - Street 1:479 S WELLINGTON RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-4731
Practice Address - Country:US
Practice Address - Phone:714-912-4431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA306005500OtherFACILITY NUMBER