Provider Demographics
NPI:1629571732
Name:ST ANTHONYS SENIOR CARE LLC
Entity type:Organization
Organization Name:ST ANTHONYS SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-579-5919
Mailing Address - Street 1:2334 M ST UNIT 3936
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-2284
Mailing Address - Country:US
Mailing Address - Phone:310-569-5919
Mailing Address - Fax:209-325-4286
Practice Address - Street 1:3337 EL CAPITAN CT
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-1406
Practice Address - Country:US
Practice Address - Phone:310-569-5919
Practice Address - Fax:209-325-4286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18-A70234253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care