Provider Demographics
NPI: | 1790102705 |
---|---|
Name: | UNIVERSAL CARE, INC. DBA BRAND NEW DAY |
Entity type: | Organization |
Organization Name: | UNIVERSAL CARE, INC. DBA BRAND NEW DAY |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | COO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JEFF |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DAVIS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 866-255-4795 |
Mailing Address - Street 1: | 5455 GARDEN GROVE BLVD FL 5 |
Mailing Address - Street 2: | |
Mailing Address - City: | WESTMINSTER |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92683-1891 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 866-255-4795 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 200 OCEANGATE STE 100 |
Practice Address - Street 2: | |
Practice Address - City: | LONG BEACH |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90802-4317 |
Practice Address - Country: | US |
Practice Address - Phone: | 888-562-5442 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-03-27 |
Last Update Date: | 2024-05-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 065312 | 302R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 302R00000X | Managed Care Organizations | Health Maintenance Organization |