Provider Demographics
NPI:1922439298
Name:DEPENDABLE NURSING SERVICES, LLC
Entity Type:Organization
Organization Name:DEPENDABLE NURSING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-602-0583
Mailing Address - Street 1:9665 CHESAPEAKE DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1367
Mailing Address - Country:US
Mailing Address - Phone:858-430-0550
Mailing Address - Fax:858-430-0564
Practice Address - Street 1:9665 CHESAPEAKE DR
Practice Address - Street 2:SUITE 401
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1367
Practice Address - Country:US
Practice Address - Phone:858-430-0550
Practice Address - Fax:858-430-0564
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPENDABLE NURSING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000223251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA70233GMedicaid