Provider Demographics
NPI:1649506171
Name:DIRECT CARE MEDICAL RESPITE INC.
Entity type:Organization
Organization Name:DIRECT CARE MEDICAL RESPITE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:661-860-2167
Mailing Address - Street 1:38713 TIERRA SUBIDA AVE
Mailing Address - Street 2:200-185
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4562
Mailing Address - Country:US
Mailing Address - Phone:661-860-2167
Mailing Address - Fax:661-233-9817
Practice Address - Street 1:38713 TIERRA SUBIDA AVE
Practice Address - Street 2:200-185
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4562
Practice Address - Country:US
Practice Address - Phone:661-860-2167
Practice Address - Fax:611-233-9817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-17
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207368251J00000X, 253Z00000X, 385H00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care