Provider Demographics
NPI:1851587224
Name:CARING CONCERN RESIDENTIAL HOMES, INC A CA CORP
Entity Type:Organization
Organization Name:CARING CONCERN RESIDENTIAL HOMES, INC A CA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:REBENSAL
Authorized Official - Suffix:
Authorized Official - Credentials:BA, QMRP
Authorized Official - Phone:805-236-8434
Mailing Address - Street 1:1576 JOSHUA PL
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-4433
Mailing Address - Country:US
Mailing Address - Phone:805-482-1576
Mailing Address - Fax:805-672-2625
Practice Address - Street 1:9002 NEATH ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-2932
Practice Address - Country:US
Practice Address - Phone:805-647-5385
Practice Address - Fax:805-627-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X, 320900000X, 320900000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-G545OtherMEDI-CAL
CA55-G094OtherMEDI-CAL
CA05-G160OtherMEDI-CAL
CA55-G510OtherMEDI-CAL