Provider Demographics
NPI:1295134302
Name:JVTCM CARE, LLC
Entity type:Organization
Organization Name:JVTCM CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:LINGBANAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:925-934-8827
Mailing Address - Street 1:1621 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2606
Mailing Address - Country:US
Mailing Address - Phone:925-934-8827
Mailing Address - Fax:925-291-2868
Practice Address - Street 1:1621 3RD AVE
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2606
Practice Address - Country:US
Practice Address - Phone:925-934-8827
Practice Address - Fax:925-291-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA075601441320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities