Provider Demographics
NPI:1205493566
Name:ARMSTRONG, CAROLINE (LVN, ADMINISTRATOR)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:LVN, ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 539
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:CA
Mailing Address - Zip Code:92359-0539
Mailing Address - Country:US
Mailing Address - Phone:909-806-0049
Mailing Address - Fax:
Practice Address - Street 1:911 HARTZELL AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2523
Practice Address - Country:US
Practice Address - Phone:909-792-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271315164X00000X
CA361880724385H00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty
No164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care