Provider Demographics
NPI:1669197620
Name:CRPA LLC
Entity type:Organization
Organization Name:CRPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:TAPANG
Authorized Official - Last Name:DITULLIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-523-8956
Mailing Address - Street 1:4016 GRAND AVE STE A-1056
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5491
Mailing Address - Country:US
Mailing Address - Phone:626-523-8956
Mailing Address - Fax:626-657-2776
Practice Address - Street 1:525 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2006
Practice Address - Country:US
Practice Address - Phone:818-240-1610
Practice Address - Fax:818-845-1169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06190FMedicaid