Provider Demographics
NPI:1821275637
Name:ST. PHILOMENA CARE HOMES, INC.
Entity Type:Organization
Organization Name:ST. PHILOMENA CARE HOMES, INC.
Other - Org Name:ST PHILOMENA CARE HOMES-I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
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 1:340 CALLE CABALLEROS
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1618
Mailing Address - Country:US
Mailing Address - Phone:909-595-9879
Mailing Address - Fax:626-839-1578
Practice Address - Street 1:340 CALLE CABALLEROS
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1618
Practice Address - Country:US
Practice Address - Phone:909-595-9879
Practice Address - Fax:626-839-1578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility