Provider Demographics
NPI:1891180659
Name:TEODORA HEALTHCARE, INC.
Entity Type:Organization
Organization Name:TEODORA HEALTHCARE, INC.
Other - Org Name:BRIGHTSTAR OF RIVERSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:GEYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-682-4838
Mailing Address - Street 1:7121 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3805
Mailing Address - Country:US
Mailing Address - Phone:951-682-4838
Mailing Address - Fax:800-450-7022
Practice Address - Street 1:45486 PEACOCK PL
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4828
Practice Address - Country:US
Practice Address - Phone:310-482-7157
Practice Address - Fax:800-450-7022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001800251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health