Provider Demographics
NPI:1700432333
Name:ORANGE CAREHOME
Entity Type:Organization
Organization Name:ORANGE CAREHOME
Other - Org Name:MAISON FOR MOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-534-0132
Mailing Address - Street 1:804 W BRENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-2125
Mailing Address - Country:US
Mailing Address - Phone:909-534-0132
Mailing Address - Fax:909-575-4530
Practice Address - Street 1:804 W BRENTWOOD AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-2125
Practice Address - Country:US
Practice Address - Phone:909-534-0132
Practice Address - Fax:909-575-4530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA306005407OtherDEPARTMENT OF SOCIAL SERVICES LICENSE