Provider Demographics
NPI:1457768848
Name:DE LEON COUNTRY MAUREEN'S HOME
Entity Type:Organization
Organization Name:DE LEON COUNTRY MAUREEN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAROTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:562-900-8789
Mailing Address - Street 1:5310 E HARCO ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1922
Mailing Address - Country:US
Mailing Address - Phone:562-900-8789
Mailing Address - Fax:562-724-7244
Practice Address - Street 1:3959 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2148
Practice Address - Country:US
Practice Address - Phone:562-900-8789
Practice Address - Fax:562-724-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities