Provider Demographics
NPI:1245930452
Name:CALIFORNIA CLINICAL CARE HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:CALIFORNIA CLINICAL CARE HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, ADMINISTRATOR, DPCS
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:JAE
Authorized Official - Last Name:CAVE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:209-408-8022
Mailing Address - Street 1:717 W ATHERTON DR APT 231
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-9531
Mailing Address - Country:US
Mailing Address - Phone:510-386-3193
Mailing Address - Fax:
Practice Address - Street 1:3600 SISK RD STE 11
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-0535
Practice Address - Country:US
Practice Address - Phone:209-408-8022
Practice Address - Fax:209-408-8294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health