Provider Demographics
NPI:1972368421
Name:CARE SAINT JACOB LLC
Entity Type:Organization
Organization Name:CARE SAINT JACOB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-394-8708
Mailing Address - Street 1:4931 CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3004
Mailing Address - Country:US
Mailing Address - Phone:949-394-8708
Mailing Address - Fax:
Practice Address - Street 1:4110 E JORDAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-5429
Practice Address - Country:US
Practice Address - Phone:949-394-8708
Practice Address - Fax:714-982-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility