Provider Demographics
NPI:1457600199
Name:CALIFORNIA CARE CORPORATION
Entity Type:Organization
Organization Name:CALIFORNIA CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VARDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MNATSAKANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-551-0026
Mailing Address - Street 1:501 E HARVARD ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1114
Mailing Address - Country:US
Mailing Address - Phone:818-551-0026
Mailing Address - Fax:818-551-0027
Practice Address - Street 1:501 E HARVARD ST
Practice Address - Street 2:UNIT A
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1114
Practice Address - Country:US
Practice Address - Phone:818-551-0026
Practice Address - Fax:818-551-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder