Provider Demographics
NPI:1659445203
Name:PHILMAR CARE LLC
Entity type:Organization
Organization Name:PHILMAR CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-987-7735
Mailing Address - Street 1:16742 ORANGE WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3809
Mailing Address - Country:US
Mailing Address - Phone:909-987-7735
Mailing Address - Fax:909-484-6809
Practice Address - Street 1:12260 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-6001
Practice Address - Country:US
Practice Address - Phone:818-899-9545
Practice Address - Fax:818-890-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA920000031314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55814FMedicaid
CALTC70160FMedicaid
CALTC70160FMedicaid