Provider Demographics
NPI:1952658049
Name:ST. BERNARDINE CARE PROVIDERS INC.
Entity Type:Organization
Organization Name:ST. BERNARDINE CARE PROVIDERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MASOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOJAEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-220-6204
Mailing Address - Street 1:18064 WIKA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2125
Mailing Address - Country:US
Mailing Address - Phone:760-242-7620
Mailing Address - Fax:760-242-6731
Practice Address - Street 1:18064 WIKA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2125
Practice Address - Country:US
Practice Address - Phone:760-242-7620
Practice Address - Fax:760-242-6731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based