Provider Demographics
NPI:1831246032
Name:ST. BERNARDINE CARE PROVIDERS,INC.
Entity type:Organization
Organization Name:ST. BERNARDINE CARE PROVIDERS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MASOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOJAEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-397-6091
Mailing Address - Street 1:6 VENTURE STE 375
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-7367
Mailing Address - Country:US
Mailing Address - Phone:949-397-6091
Mailing Address - Fax:949-629-4179
Practice Address - Street 1:18064 WIKA RD STE 202
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2182
Practice Address - Country:US
Practice Address - Phone:760-242-6720
Practice Address - Fax:760-242-6731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058486Medicare Oscar/Certification