Provider Demographics
NPI:1922289644
Name:RCN PEDIATRIC CARE III
Entity Type:Organization
Organization Name:RCN PEDIATRIC CARE III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:
Authorized Official - Last Name:NARNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-917-9385
Mailing Address - Street 1:1429 GREENBERRY DR
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1429 GREENBERRY DR
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1046
Practice Address - Country:US
Practice Address - Phone:626-917-9385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility